Clinical observation of chiropractic manipulation in the treatment of degenerative scoliosis / 中国骨伤

OBJECTIVE@#To observe clinical efficacy of chiropractic manipulation in the treatment of degenerative scoliosis (DS).@*METHODS@#From June 2017 to September 2019, 120 patients with degenerative scoliosis were randomly divided into treatment group (60 cases) and control group(60 cases). The patients in treatment group were treated with chiropractic manipulation once every other day for 4 weeks. The patients in control group were treated with eperisone hydrochloride tablets combined with thoracolumbar orthopedic(TSLO)brace, oral eperisone hydrochloride tablets 50 mg three times a day, wearing TSLO brace for not less than 8 hours a day. The course of treatment was 4 weeks. After the patients were selected into the group, visual analogue scale (VAS) and Oswestry Disability Index (ODI) were recorded before treatment, 1, 2, 3, 4 weeks after treatment and 1 month after treatment. The full length X-ray of the spine was taken before and 4 weeks after treatment, and the scoliosis Cobb angle, sagittal vertical axis (SVA) and lumbar lordosis (LL) were measured and compared. The adverse reactions during the treatment were recorded.@*RESULTS@#There were significant differences in VAS and ODI between two groups at each time point after treatment (P<0.001), VAS and ODI at 2 weeks after treatment (PVAS=0.025, PODI=0.032) and 3 weeks after treatment(PVAS=0.040, PODI=0.044) in treatment group were significantly different from those in control group, but there was no significant difference in VAS and ODI at other time points between treatment group and control group (P>0.05). There was significant difference in Cobb angle between treatment group(P=0.010) and control group(P=0.017) after treatment, but there was no significant difference in LL and SVA between treatment group and control group. There was no significant difference in Cobb angle, LL and SVA between two groups before and after treatment. During the treatment, there were 4 mild adverse reactions in the control group and no adverse reactions in the treatment group.@*CONCLUSION@#Chiropractic manipulation can effectively relieve pain and improve lumbar function in patients with degenerative scoliosis. The onset of action is faster than that oral eperisone hydrochloride tablets combined with TSLO brace, and it has better safety and can improve Cobb angle of patients with degenerative scoliosis.

Letter to the Editor: A Case of Posterior Inferior Cerebellar Artery Infarction after Cervical Chiropractic Manipulation (Korean J Neurotrauma 2018;14:159–163) / 대한신경손상학회지

No abstract available.

Authors' Reply to Letter to the Editor: A Case of Posterior Inferior Cerebellar Artery Infarction after Cervical Chiropractic Manipulation (Korean J Neurotrauma 2018;14:159–163) / 대한신경손상학회지

No abstract available.

Treatment of sacroiliac joint dislocation by Zhuang medicine tendon therapy combined with chiropractic manipulation / 中国骨伤

OBJECTIVE@#To analyze the clinical effect of Zhuang medicine tendon therapy combined with chiropractic manipulation in treating sacroiliac joint dislocation.@*METHODS@#From January 2017 to May 2018, 60 patients with sacroiliac joint dislocation were divided into treatment group and control group according to the order of admission. There were 19 males and 11 females in the treatment group, aged from 23 to 52 (38.97±3.23) years old, with a course of 2 h to 5.1 months, with an average of (2.19±1.12) months. There were 14 males and 16 females in the control group, aged from 26 to 50 (39.07±3.30) years old, with a course of 3 h to 6 months, with an average of(2.41±1.05) months. The treatment group was treated with Zhuang medicine tendon therapy combined with chiropractic manipulation, while the control group was treated with conventional acupuncture and massage. Before treatment, the main clinical symptoms of the patients were lumbosacral pain, posterior superior iliac spine not at the same level and accompanied with dyskinesia. The pelvic separation test and the "4" test were positive. After treatment, the curative effect was evaluated according to the improved Macnab standard and the "score of treatment of lumbar diseases".@*RESULTS@#Sixty patients were followed up for an average of 8 months. At the latest follow-up, the clinical effect of modified Macnab was better in the treatment group than in the control group(<0.01). After treatment, the treatment group was better than the control group on lumbar function score (<0.01).@*CONCLUSIONS@#The treatment of sacroiliac joint dislocation by Zhuang medicine tendon therapy combined with chiropractic manipulation has good clinical effect and is worth further application and development.

A Case of Posterior Inferior Cerebellar Artery Infarction after Cervical Chiropractic Manipulation / 대한신경손상학회지

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.

Effectiveness of chiropractic adjustment in lumbar pain in crossfit practitioners / Eficácia do ajuste quiroprático nas dores lombares em praticantes de crossfit / Eficacia del ajuste quiropráctico en los dolores lumbares en practicantes de crossfit

ABSTRACT Objective: To evaluate the efficacy of acute chiropractic adjustment in individuals who practice CrossFit with regard to complaints of low back pain and the joint range of motion in this region. Methods: A randomized clinical trial comprised of CrossFit practitioners from a box in Novo Hamburgo-RS, of both sexes and aged 18 to 40 years who had low back pain at the time of the study. The following tools were used: Semi-structured Anamnesis Questionnaire, Visual Analog Scale, McGill Pain Questionnaire, and SF-36 Quality of Life Questionnaire. Individuals in the control group answered the questionnaires before and after CrossFit training. The chiropractic group performed the same procedure, plus pre-training chiropractic adjustment and joint range of motion (ROM) before and after lumbar adjustment. Results: There was a significant increase in pain in the control group, and a significant decrease in pain in the chiropractic group, including one day after the chiropractic adjustment. In the chiropractic group, the joint ranges of motion had a significant increase in flexion and extension of the lumbar spine after chiropractic adjustment. Conclusion: The chiropractic group achieved a significant improvement in pain level and joint range of motion, suggesting that acute chiropractic adjustment was effective in reducing low back pain.

RESUMO Objetivo: Avaliar a eficácia do ajuste quiroprático agudo em indivíduos praticantes de CrossFit com relação às queixas de dores lombares e à amplitude de movimento articular nessa região. Métodos: Estudo clínico randomizado, composto por praticantes de CrossFit de um box de Novo Hamburgo/RS, de ambos os sexos e com idades de 18 a 40 anos que tinham dor lombar na ocasião da pesquisa. Foram usados os instrumentos Ficha de Anamnese Semiestruturada, Escala Visual Analógica, Questionário de dor McGill e Questionário de Qualidade de Vida SF-36. Os indivíduos do grupo controle responderam os questionários antes e depois do treino de CrossFit. O grupo quiropraxia realizou o mesmo procedimento, acrescido do ajuste quiroprático pré-treino e da medição da amplitude de movimento (ADM) articular antes e depois de ajuste lombar. Resultados: Observaram-se aumento significativo de dor no grupo controle e diminuição significativa de dor no grupo quiropraxia, inclusive um dia após o ajuste quiroprático. No grupo quiropraxia, as amplitudes de movimento articular tiveram aumento significativo na flexão e na extensão da coluna lombar após o ajuste quiroprático. Conclusão: O grupo quiropraxia obteve uma melhora significativa no nível de dor e na amplitude de movimento articular, sugerindo que o ajuste quiroprático agudo foi eficaz na redução da dor lombar.

RESUMEN Objetivo: Evaluar la eficacia del ajuste quiropráctico agudo en individuos que practican CrossFit con relación a las quejas de dolores lumbares y el rango de movimiento articular en esa región. Método: Ensayo clínico aleatorizado compuesto por practicantes de CrossFit de un box de Novo Hamburgo-RS, de ambos sexos y con edades de 18 a 40 años que tenían dolor lumbar en ocasión de la investigación. Se utilizaron los cuestionarios Ficha de Semi-estructurada de Anamnesis, Escala visual analógica, cuestionario de McGill y el Cuestionario de Calidad de vida SF -36. Los individuos del grupo control respondieron los cuestionarios antes y después del entrenamiento de CrossFit. El grupo quiropráctico realizó el mismo procedimiento, incrementado de ajuste quiropráctico pre-entrenamiento y de la medición del rango de movimiento (RM) articular antes y después de ajuste lumbar. Resultados: Se observó un aumento significativo de dolor en el grupo control y disminución significativa del dolor en el grupo quiropráctico, incluso un día después del ajuste quiropráctico. En el grupo quiropráctico, los rangos de movimiento articular tuvieron un aumento significativo en la flexión y extensión de la columna lumbar después del ajuste quiropráctico. Conclusión: El ajuste quiropráctico agudo logró una mejora significativa en el nivel de dolor lumbar y en el rango de movimiento articular, sugiriendo que el ajuste quiropráctico agudo fue eficaz en la reducción del dolor lumbar.

Bilateral Vertebral Artery Dissection after a Chiropractic Therapy Session

Vertebral artery dissection (VAD) is a rare and sometimes unrecognized cause of stroke in patients younger than 45 years. Herein, we describe a very rare case of bilateral vertebral artery dissection after a session of cervical therapy manipulation (chiropractic).

Vertebral artery dissection (VAD) is a rare and sometimes unrecognized cause of stroke in patients younger than 45 years. Herein, we describe a very rare case of bilateral vertebral artery dissection after a session of cervical therapy manipulation (chiropractic).

Efeitos do tratamento quiroprático na concentração sérica de proteína C-reativa e nos sintomas de indivíduos com cervicalgia / Effects of chiropractic treatment on serum C-reactive protein and in the symptoms of individuals with neck disorders

Introdução: cervicalgia é a segunda queixa principal mais prevalente relatada pelos pacientes que procuram tratamento quiroprático, e acomete 55% da população (KNOPLICH, 2003; LEAVER et al., 2007). A manipulação vertebral altera a entrada dos sinais sensórios dos tecidos paraespinhais de maneira a melhorar a função fisiológica 3. A função da proteína C-reativa (PCR) in vivo não está bem definida e os resultados de estudos com animais experimentais têm produzido resultados contraditórios. Métodos: em um estudo quase experimental, a concentração sérica de proteína C-reativa após tratamento quiroprático foi determinada em 12 pacientes, sendo seis sintomáticos à cervicalgia e seis assintomáticos. Foram realizadas coletas sanguíneas. A partir das amostras foi dosada a concentração plasmática de proteína C-reativa. Resultados: os resultados sugerem que a manipulação quiroprática estimula a produção de interleucinas que, por sua vez, aumenta a produção da PCR para combater a inflamação. Dessa forma, a melhora do processo inflamatório provocada pelo procedimento quiroprático pode reduzir a descarga dos aferentes nociceptivos e, desta forma, reduzir a sensação de dor. Conclusão: existe uma tendência ao aumento da concentração da PCR, e a diminuição da dor, o que sugere efeitos benéficos da manipulação articular vertebral sobre eventos inflamatórios e nociceptivos. (AU)

Introduction: Neck pain is the second most prevalent chief complaint reported by patients who seek chiropractic care, and affects 55% of the population (KNOPLICH, 2003; LEAVER et al., 2007). The spinal manipulation, in theory, change the entry of sensory signals from paraspinal tissues in order to improve the function physiological 3. The role of C-reactive protein (CRP) in vivo is not well defined and the results of experimental animal studies have produced contradictory results. Methods: A quasiexperimental study, the serum C-reactive protein after chiropractic treatment was determined in 12 patients, 6 with symptomatic and 6 asymptomatic neck. Blood were collected. From the samples was measured plasma concentration of C-reactive protein. Results: The results suggest that chiropractic manipulation stimulates the production of interleukins that in turn, increases the production of CRP to fight inflammation. Thus, the improvement of the inflammatory process caused by the chiropractic procedure can reduce the discharge of nociceptive afferents and thereby reduce the sensation of pain. Conclusion: There is a tendency to increased concentration of CRP and reduction of pain, suggesting beneficial effects of joint manipulation on spinal nociceptive and inflammatory events. (AU)

A randomized controlled trials on treatment of cervicogenic sudden hearing loss with chiropractic / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effect and safety of chiropractic in treating cervicogenic sudden hearing loss.</p><p><b>METHODS</b>From January 2011 to October 2013, 90 patients with cervicogenic sudden hearing loss were randomly divided into treatment group and control group according to the random number table produced by SPSS 19.0 software. In the treatment group, there were 17 males and 28 females, aged from 31 to 62 years old with an average of (47.57±9.43) years; course of disease was from 1 to 3 days with an average of (1.43±0.68) days; pure-tone audiometry score was from 46.5 to 77.8 dB with the mean of (61.20±9.83) dB; Northwick Park Neck Pain Questionnaire (NPQ) score was from 17 to 31 scores with an average of (23.46±7.18) scores. In the control group, there were 15 males and 30 females, aged from 28 to 64 years old with an average of (45.77±6.99) years; course of disease was from 1 to 3 days with an average of (1.50±0.73) days; pure-tone audiometry score was from 48.1 to 75.0 dB with the mean of (63.91±8.05) dB; Northwick Park Neck Pain Questionnaire (NPQ) score was from 20 to 29 scores with an average of (25.61±10.43) scores. The patients of control group were treated with dexamethasone intravenous drip of 10 mg, 3 days later, decreased to 5 mg, 3 days again. And with the methycobal intravenous drip of 500 μg, treatment continued for 10 days. The patients of treatment group were treated with chiropractic additionally except for the therapeutic methods of control group. Chiropractic included local muscle loosening, attacking point, bilateral pulling atlanto-axial joint, and continuous treatment for 10 days. The pure-tone audiometry score and NPQ score were compared between two groups after treatment.</p><p><b>RESULTS</b>After the treatment, pure-tone audiometry score and NPQ score in treatment group improved to (40.23± 8.14) dB and (12.70±8.29) scores respectively, which were obviously better than that of control group's (37.70±10.61) dB and (21.24±11.13) scores (P<0.05).</p><p><b>CONCLUSION</b>Compared with routine method for cervicogenic sudden hearing loss, additional chiropractic can improve hearing and relieve neck pain effectively.</p>

Spinous process fractures after chiropractic massage in a previously healthy subject / Fratura de processo espinhoso após terapia quiroprática em um indivíduo previamente saudável

Increasing available alternative therapies to the treatment of back pain and sometimes difficult access to specialized medical evaluations allowed a widespread use of alternative therapies for the treatment of back pain. We describe a case with a consequence of massage therapy in a patient with initial symptoms of back pain resulting in spinous process fractures. She promptly searched medical attendance and cervical plain radiograph revealed avulsion of spinous processes of C6 and C7 in their outer third. Due to benign nature of lesion, without evidence of instability and spinal cord injury, the subject was managed conservatively, with application of a Philadelphia collar and analgesic medication. We reinforce the needof medical attention before beginning any therapeutic method in order to identify previous alterations and plan an adequate programming.

A disponibilidade de terapias alternativas para o tratamento da dor lombar e o difícil acesso a serviço médico especializado têm permitido um uso indiscriminado de terapias para o tratamento dessa dor. Descrevemos um caso de uma paciente submetida à terapia quiroprática por causa de dor cervical que evoluiu posteriormente com persistência da dor. A investigação radiológica evidenciou fratura com avulsão de processos espinhosos de C6 e C7. Por causa da natureza estável da lesão, o caso foi conduzido conservadoramente com colar Philadelphia, no entanto reforçamos a necessidade do correto diagnóstico da dor de coluna espinhal, especialmente se persistente e associada a sinais localizatórios.

Associação entre postura sentada e alterações posturais da coluna vertebral no plano sagital de escolares de Lajeado, RS / Association between posture and chandes in spine on sagital plane of students in Lajeado, RS

O objetivo deste estudo foi identificar a prevalência das alterações da colunavertebral no plano sagital e dos hábitos adotados na postura sentada para escrever e sentadapara utilizar o computador, assim como verificar se existe associação entre a postura sentadae a postura estática em pé. A amostra foi composta por 75 escolares da cidade de Lajeado,Rio Grande do Sul. Os escolares responderam ao questionário BackPEI para obtençãode informações acerca da postura que adotam ao sentar para escrever e ao utilizar ocomputador. As curvaturas torácicas e lombares dos escolares foram avaliadas e mensuradaspor meio de um arcômetro. Os dados foram analisados no SPSS, através estatística descritiva ede razões de prevalência, com variância robusta (alfa=0,05). Os resultados indicaram que 20 por centodos escolares apresentaram alterações na coluna torácica e 37,4 por cento apresentaram alterações nacoluna lombar. Em relação às posições sentadas, grande parte dos escolares adotam posturasinadequadas ao sentar para utilizar o computador (86,7 por cento) e para escrever (89,3 por cento), sendoessa última associada significativamente às alterações na coluna torácica. Conclui-se que osescolares, quando na posição sentada, apresentam posturas inadequadas, o que parece estarrelacionado com as alterações posturais da coluna vertebral na posição em pé...

The objective of this study was to identify the prevalence of spinalabnormalities in the sagital plane and habits adopted in the “writing’s sitting posture”and the “sitting in front of the computer posture” as well as to investigate the associationbetween sitting posture and standing static posture. The sample consisted of 75 studentsfrom Lajeado, Rio Grande do Sul, Brazil. To obtain information about the posture theyadopt to sit down to write and use the computer, the school children were asked to answerthe BackPEI questionnaire. Thoracic and lumbar curvatures of the subjects were measuredand evaluated using an arcometer. Data were analyzed with SPSS, through descriptivestatistics and prevalence ratios, with a robust variance (alpha=0.05). The results indicated that20 percent of the students showed changes in the thoracic spine and 37.4 percent showed changes inthe lumbar spine. Regarding seating positions, most of the students adopt inadequatepostures when sitting to use the computer (86.7 percent) and to write (89.3 percent), the latter beingsignificantly associated with changes in the thoracic spine. It was concluded that thestudents, when seated, have poor posture, which seems to be related to postural changes inthe spine in the standing position...

El objetivo de este estudio fue identificar la prevalencia de las alteracionesen la columna vertebral en el plan sagital y hábitos adoptados en la postura sentada paraescribir y sentada para usar la computadora, así como para verificar si hay asociaciónentre la postura sentada y la estática de pie. La muestra fue de 75 estudiantes de laciudad de Lajeado, Rio Grande do Sul. Los estudiantes respondieron al cuestionarioBackPEI para obtener información sobre la postura que adoptan al sentarse a escribiry usar la computadora. Las curvaturas torácica y lumbar de los estudiantes fueronevaluadas y medidas por medio de un arco metro. Los datos fueron analizados utilizando el programa SPSS, a través de la estadística descriptiva y las razones de prevalencia convarianza robusta (alfa=0,05). Los resultados indicaron que el 20 percent de los estudiantesmostraron alteraciones en la columna torácica y 37,4 percent presentaron alteraciones en lacolumna lumbar. En cuanto a posiciones sentadas, la mayoría de los estudiantes adoptaposturas inadecuadas al sentarse a utilizar la computadora (86,7 percent) y escribir (89,3 percent), siendola última asociada significativamente con los cambios en la columna torácica. Se concluyeque la escuela, una vez sentado, tiene una postura inadecuada, lo que parece estarrelacionado con los cambios posturales de la columna vertebral en la posición de pie...

Clinical observation on cervical type cervical spondylosis treated with sword-like needle and chiropractic spinal manipulation / 中国针灸

<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>

Quiropraxia / Chiropractic

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.

Alterações posturais em cirurgiões provocadas pela atividade profissional / Profession-related postural changes in surgeons", "_e": "n

INTRODUÇÃO: Qualquer desvio da postura padrão é considerado alteração postural, o que não é necessariamente classificado como doença, embora afete consideravelmente a qualidade de vida dos profissionais cirurgiões. O objetivo deste estudo foi avaliar o alinhamento e o controle posturais de médicos cirurgiões e não-cirurgiões, a fim de identificar e quantificar o posicionamento dos segmentos corporais e averiguar comparativamente possíveis alterações posturais. MÉTODO: Participaram do estudo 30 sujeitos no grupo teste (CI), que atenderam aos seguintes critérios de inclusão: ser médico, idade entre 30 anos e 60 anos, com, no mínimo, 2 anos de prática cirúrgica e 4 cirurgias semanais com duração de 2 horas cada uma. O grupo comparativo (CL) constituiu-se de 32 sujeitos, médicos clínicos, com idade similar ao do grupo CI. O grupo controle (CO) constituiu-se de 33 sujeitos não-médicos, com a mesma faixa etária dos grupos CL e CI, que atendiam aos seguintes critérios de exclusão: presença de dor musculoesquelética crônica ou dor aguda intensa; diagnóstico ou sequela de doença ortopédica, reumatológica ou respiratória; ou utilização de prótese. RESULTADOS: Observou-se alta incidência de alterações posturais no grupo CI, como joelho varo, hiperextensão, hiperlordose lombar e pé com maior apoio em calcâneo, além de outros desalinhamentos. Os resultados indicam que as atividades dos cirurgiões podem ser consideradas de risco para o sistema musculoesquelético. Por ser eminentemente cirúrgica, a especialidade de cirurgia plástica é de risco ainda maior. CONCLUSÕES: A atividade cirúrgica provoca alterações posturais progressivas nos cirurgiões, podendo reduzir a vida útil na profissão e prejudicar a qualidade de vida.

BACKGROUND: Any deviation from the standard posture is considered a postural alteration; although this is not necessarily considered a disease, it may substantially affect the quality of life of surgeons. The aim of this study was to evaluate backbone alignment and posture in surgeons and physicians in order to identify and quantify the positioning of body segments and investigate possible postural alterations. METHODS: Thirty subjects participated in the study group (CI) and corresponded to the following inclusion criteria: physician, aged 30-60 years, with at least 2 years of surgical practice and performing 4 weekly surgeries lasting 2 h each. The comparative group (CL) included 32 clinical physicians, in the same age range as the CI group. The control group (CO) included 33 non-physicians in the same age range as the CL and CI groups, who satisfied the following exclusion criteria: chronic muscle-skeletal pain or acute intense pain, diagnosis of or sequelae from orthopedic, rheumatologic, or respiratory disease, or prosthetic use. RESULTS: We observed a high incidence of postural changes in the CI group, including varus thrust, hyperextension, lumbar hyperlordosis, and more foot support in the heel, and other misalignments. The results indicate that the activities of surgeons may be considered as a risk for the musculoskeletal system. Because the specialty of plastic surgery is particularly surgical, the risk is even higher in these surgeons. CONCLUSIONS: Surgical activity provokes progressive postural changes in surgeons and may reduce useful time in the profession and hinder the quality of life.

Análise da postura craniocervical de crianças respiradoras bucais após tratamento postural em bola suíça / Craniocervical posture analysis of mouth breathing children after postural treatment on swiss ball

O estudo teve como objetivo avaliar a postura craniocervical de crianças respiradoras bucais após tratamento postural em bola suíça. Doze crianças respiradoras bucais foram submetidas a um protocolo de reeducação postural constituído por exercícios de alongamento e fortalecimento muscular sobre a bola suíça, estimulação diafragmática e alongamento dos músculos acessórios da inspiração. A postura craniocervical foi avaliada através da análise biofotogramétrica. A posição da anteriorização da cabeça foi aferida por meio do ângulo formado pelos pontos localizados no tragus direito e no processo espinhoso da sétima vértebra cervical com a linha horizontal. A curvatura cervical foi avaliada pela distância horizontal de uma linha vertical tangenciando o ápice da cifose torácica e o ponto de maior concavidade da curvatura cervical. As fotografias foram obtidas antes e após dez atendimentos. A normalidade das variáveis foi verificada a partir do teste Shapiro-Wilk. Para as comparações entre as médias foi utilizado o teste t de Student para amostras dependentes admitindo-se nível de significância de 5% (p<0,05). Verificou-se uma melhora na postura craniocervical, através da diminuição da anteriorização da cabeça (p=0,00) e do restabelecimento da curvatura fisiológica da coluna cervical (p=0,01). O tratamento postural em bola suíça proporcionou um melhor alinhamento da postura craniocervical, provavelmente pelo equilíbrio dos músculos cervicais e maior ação diafragmática.

The study aimed to evaluate the craniocervical posture of mouth breathing children after postural treatment on swiss ball. Twelve mouth breathing children were undergone to a postural reeducation protocol through stretching and strengthening exercises on swiss ball, diaphragmatic stimulation and stretching of the inspiratory accessory muscles. Craniocervical posture was evaluated through biophotogrammetry analysis. Forward head position was measured through an angle formed by the points in the tragus and in the spinous process of the seventh cervical vertebra with a horizontal line. Cervical column curvature was taken by the horizontal distance from a vertical line passing through the thoracic kyphosis apex to the point of the greatest cervical curvature concavity. Pictures were taken before and after ten treatment sessions. The normality of the variables was tested by Shapiro-Wilk test and the Student's t -test was used to determine differences in variables between assessments. It was considered a significance level of 5% (p<0.05). It was verified a significant improvement on craniocervical posture with reduction of the forward head position (p=0.00) and restoration of cervical column physiological curvature (p=0.01). The postural reeducation protocol on swiss ball reflected on craniocervical posture alignment probably by cervical muscles equilibrium and diaphragmatic action improvement.

Efeito da reeducação postural global e do isostretchingem portadores de lombalgia crônica inespecífica atravésda biofotogrametria computadorizada / Effects of global posture re-education and isostretching in patients with chronic non-specific low back pain assessed by the computerized biophotogrametry method

O objetivo deste estudo foi quantificar os efeitos da ReeducaçãoPostural Global (RPG) e do Isostretching em portadoresde lombalgia crônica inespecífica (LCI) através do método daBiofotogrametria Computadorizada. 30 portadores de LCI foramacompanhados no Instituto Ortopédico de Palmas (IOP). Ospacientes foram submetidos a procedimentos como: avaliação fisioterápicaatravés do Instrumento de Avaliação da Coluna Vertebral,Escala Visual Analógica de Dor (EVA), Avaliação pelo método daBiofotogrametria Computadorizada antes da 1ª sessão e após trêsmeses de tratamento (2ª avaliação), e reavaliados após dois mesespós-tratamento (3ª avaliação). Os resultados obtidos através dotratamento com base na avaliação da Biofotogrametria Computadorizadaforam que não houve efeito estatisticamente significativodo fator Grupo, nem do fator Tempo, nem da interação entre osdois fatores (valor de p > 0,05) sobre as medidas de concavidadelombar ou convexidade torácica. Conclui-se que o método doRPG aumentou a concavidade lombar e diminuiu a convexidadetorácica quando os pacientes foram submetidos ao método daBiofotogrametria Computadorizada através da quantificação dascurvas fisiológicas da coluna vertebral. O método do Iso não alterouas curvas fisiológicas da coluna vertebral. Quando os dois métodosforam associados (Iso + RPG), a concavidade lombar diminuiu e aconvexidade torácica se manteve.

This study aimed at quantifying the effects of Global PostureRe-education (GPR) and Isostretching (Iso) in patients withchronic non-specific low back pain using the ComputerizedBiophotogrametry method. This research was performed in 30patients followed at the Orthopedic Institute of Palmas (IOP). Thepatients were submitted to Iso or GPR and to the following treatmentassessment procedures: physical therapy evaluation using theVertebral Column Instrument, Visual Analogic Pain Scale (EVA).The subjects were evaluated by Computerized Biophotogrametrybefore the 1st session and after three months of treatment, andre-evaluated two months after the final interventions. Treatmentresults, as judged from Computerized Biophotogrametry data, andconcerning lumbar concavity or thoracic convexity measurements,were not statistically significant with regard to the Group factor,the Time factor, or the interaction between these factors (value p >0.05). Thus we conclude that the GPR method tended to increaselumbar concavity and decreased thoracic convexity, according toComputerized Biophotogrametric data. The Iso method did notchange the physiologic curves of the vertebral column. When thetwo methods were associated (Iso + GPR), lumbar concavity decreasedand thoracic convexity was maintained. These different results,however, did not reach statistical significance.

A Case of Central Retinal Artery Occlusion after Chiropractic Manipulation of the Neck

Here we report a case of central retinal artery occlusion after chiropractic manipulation on the neck. A 49-year old man presented at the hospital because of sudden visual loss in his right eye after chiropractic neck manipulation. He had received chiropractic manipulation of the neck by a chiropractor eight days prior. When he first visited us, his best corrected visual acuity in his right eye was hand motion. A full ophthalmic examination was performed. There was cherry-red spot in the macula in his right eye. We performed a fluorescein angiogram and cervical color Doppler. The arterio-venous transit time in the fluorescein angiogram was delayed, and we detected stenosis of the right internal carotid artery with diffuse atherosclerotic plaques in the right common carotid artery. We prescribed ginko biloba extract (Tanamin). Three years after his first visit, the best corrected visual acuity of his right eye was 20 / 200.

Educative games and expositive lesson: comparison of educational techniques on sitting posture

INTRODUÇÃO: Estudos sobre educação em saúde são importantes para a concretização de ações de promoção da saúde. OBJETIVO: verificar as mudanças de conhecimentos teóricos sobre postura sentada, avaliados em dois momentos (inicial e final,) considerando dois programas de educação (aula expositiva e grupos operativos). MÉTODO: Foram sujeitos 75 alunos, de ambos os sexos, de três 4as séries de uma escola pública, avaliados previamente (A1) sobre postura sentada; o grupo 1 foi submetido a um procedimento de ensino expositivo, o 2 a jogos educativos e o 3 a nenhuma intervenção. Após uma semana foram reavaliados (A2). Para os momentos aplicou-se o teste de Wilcoxon e entre os grupos Kruskal Wallis. RESULTADOS: Na comparação dentro dos grupos, os 2 e 3 apresentaram aumento no número de acertos sobre postura sentada no pós-teste, com diferença estatisticamente significante, enquanto que no grupo controle, tal fato não ocorreu. Na comparação entre grupos, no primeiro momento (A1), os grupos 2 e 3 não apresentaram diferença estatisticamente significante (p>0,05), no entanto, no segundo momento nota-se que houve diferença estatística entre os três grupos (p < 0,01), sendo que o G3 apresentou menor freqüência de erros (Md = 5) em relação ao G2 (Md = 8) e G1 (Md = 10). CONCLUSÕES: Pode-se afirmar que técnicas educativas que fornecem informações e promovem debates e trocas de experiências entre os participantes aumentam as chances de incorporação dos conteúdos relacionados à postura sentada.

Redução do limite de estabilidade direção-específica em indivíduos leve a moderadamente afetados pela doença de Parkinson / Direction-specific limits of stability are reduced in mild to moderate Parkinson's disease individuals

A instabilidade postural na doença de Parkinson (DP) tem sido associada a uma diminuição do limite de estabilidade (LE) na direção ântero-posterior (AP). Entretanto, ainda que possíveis alterações do LE na direção látero-lateral (LL) tenham sido sugeridas, tal direção não tem sido avaliada nos estudos com DP, principalmente quando o teste de limite de estabilidade (TLE) envolve movimentos intencionais que deslocam o centro de massa corporal (CMC). O objetivo do presente estudo foi investigar o LE na postura de pé durante movimentos voluntários que promovem deslocamento do CMC nas direções AP e LL de indivíduos com e sem a DP. Doze indivíduos com DP (Hoehn & Yahr=II, III) e 12 sem a doença realizaram o TLE nos sentidos anterior, posterior, direito e esquerdo. A velocidade de movimento (VM), excursão máxima (EM) e o controle direcional (CD) do CMC foram avaliados em cada sentido. Os indivíduos com DP foram significativamente mais lentos em todos os sentidos de deslocamento do CMC (p<0,05). Não houve diferença significativa na EM e CD no sentido anterior entre os grupos (p>0,05). Por outro lado, a EM e CD do CMC foram menores para o grupo DP no sentido posterior (P) e na direção LL (p<0,05). Indivíduos leves a moderadamente afetados pela DP apresentaram redução do LE no sentido P e na direção LL quando comparados ao grupo controle. Os resultados sugerem que tal direção e sentido devam ser treinados em ortostatismo, com movimentos que deslocam voluntariamente o CMC, desde fases iniciais da DP.

Postural instability in Parkinson's disease (PD) has been associated with decreases of the limits of stability (LOS) in the anterior-posterior (AP) directions. Although LOS changes in the latero-lateral (LL) directions have been suggested, they have not been evaluated in studies with PD, especially when the LOS tests involve intentional displacements of the body center of mass (COM). The aim of this study was to investigate the LOS in standing posture during voluntary movements that promote movement of the COM in AP and LL directions of individuals with and without PD. Twelve subjects with PD (Hoehn & Yahr stages of II and III) and 12 without the disease performed the LOS tests in the anterior, posterior, right and left directions. The movement velocity (MV), maximum excursion (ME), and directional control (DC) of the COM were evaluated in all investigated directions. Individuals with PD demonstrated smaller COM displacements in all directions (p<0.05). There were no significant differences between the groups regarding the ME and DC in the anterior direction (p>0.05). However, the ME and DC of the COM were smaller for the PD group in the backward, right, and left directions (p<0.05). Individuals with mild to moderate PD demonstrated decreases in the LOS in the posterior and LL directions, when compared to individuals without the disease. These findings suggested that such directions should be trained in the standing position with voluntary movements of the COM from the early stages of PD.

Perfil dos desvios posturais da coluna vertebral em adolescentes de escolas públicas do município de Juazeiro do Norte - CE / Profile of postural deviations of the spine in adolescents from public schools in the city of Juazeiro do Norte - CE

Postura é definida como sendo a posição adotada pelo ser humano. Dados epidemiológicos apontam para uma alta prevalência de alterações posturais de coluna entre crianças e adolescentes. O objetivo do presente estudo foi investigar os desvios posturais da coluna vertebral em escolares (n=670) de 11 a 19 anos. Utilizou-se como metodologia um simetrógrafo e uma máquina fotográfica para pesquisar a presença de desvios na coluna vertebral. Foram utilizados um nível d'água e uma régua para aferir a gibosidade, um fio de prumo e uma régua para medir os desvios laterais da coluna. Dos resultados obtidos, encontrou-se uma prevalência de 8,8% de desvios laterais e 2,4% de gibosidade, além de ser observada a presença de escoliose em portadores de assimetrias de ombros e ilíacos. Porém, não houve influência do peso, altura e índice de massa corporal (IMC) para a prevalência de escoliose. Dessa maneira, com este estudo, constatou-se elevada prevalência dos desvios posturais em escolares.

Posture is defined as the position taken by humans. Epidemiological data indicate a high prevalence of backbone postural changes among children and adolescents. The aim of this study was to investigate the postural deviations of the spine in schoolchildren (n=670) from 11 to 19 years. The methodology used was a simetrograf and a camera for the presence of deviations in the spine. We used a water level and a ruler to measure the spinal deformity, a plumb line and a ruler to measure the lateral deviation of the spine. Of the obtained results it was found a prevalence of 8.8% of lateral deviation and 2.4% of gibbosity, besides it was observed the presence of scoliosis in patients with asymmetries in the shoulders and hipbones. However, there was no influence of weight, height and body mass index (BMI) for the prevalence of scoliosis. Thus, through this study, it was stated the high prevalence of postural deviations in schoolchildren.