Effect of spinal manipulation therapy on chronic nonspecific neck pain: a meta-analysis / 中国康复理论与实践

@#Objective To evaluate the effects of spinal manipulation therapy (SMT) on chronic nonspecific neck pain (CNSNP) by using World Health Organization Family International Classifications (WHO-FICs). Methods Randomized controlled trials (RCTs) about the effects of SMT on CNSNP were searched from PubMed, Web of Science, Cochrane Library, EMBASE, EBSCO, CBM and CNKI from database establishment to December 31st, 2021. At least two researchers extracted the data. Cochrane bias risk assessment tool and Physiotherapy Evidence Database Scale were used to evaluate the quality of the included articles. Revman 5.4 software and Stata 16.0 software were used for meta-analyses and publication bias analysis respectively. Results A total of 15 RCTs that represented 1 067 participants were evaluated. In terms of body functions, compared with the control group, SMT significantly reduced Visual Analog Score for pain (MD = -0.85, 95%CI -1.06 to -0.63, P < 0.00001) and Numerical Rating Scale (MD = -0.92, 95%CI -1.29 to -0.55, P < 0.001), increased pressure pain thresholds (SMD = 0.67, 95%CI 0.47 to 0.86, P < 0.001), cervical range of motion (ROM) of flexion/extension (SMD = 0.51, 95%CI 0.33 to 0.68, P < 0.001) and rotation (SMD = 0.20, 95%CI 0.01 to 0.38, P = 0.04), improved root mean square of cervical muscles electromygraphy (MD = 2.17, 95%CI 0.06 to 4.29, P = 0.04), but not significantly in cervical ROM of lateral flexion (SMD = 0.19, 95%CI -0.00 to 0.38, P = 0.06), cervical strength (SMD = -0.18, 95%CI -0.84 to 0.49, P = 0.60) and endurance (SMD = 0.18, 95%CI -0.39 to 0.75, P = 0.53). In term of activities and participation, SMT significantly improved cervical disability (MD = -0.96, 95%CI -1.55 to -0.38, P = 0.001), but not significantly in health status of patients with CNSNP (SMD = 0.08, 95%CI -0.03 to 0.20, P = 0.15). Conclusion SMT could improve pain intensity, pain sensitivity, cervical ROM and disability in patients with CNSNP, but its efficacy on muscle function, proprioception and health status is unclear.

Variação da resposta sintomática dolorosa na coluna lombar pela manipulação visceral / Variation of painful symptomatic response in the lumbar spine by visceral manipulation

Introdução: A manipulação visceral é atualmente um tratamento usado amplamente pelos osteopatas no mundo, contudo, sua base de mecanismos ainda é pouco esclarecida, havendo certa escassez de pesquisas publicadas sobre tais intervenções. O conceito para o tratamento se baseia na ação sobre aderências fáscias que supostamente afetam a hemodinâmica visceral, desregulação autonômica, fatores psicossomáticos e ptose visceral, repercutindo de maneira direta no bom funcionamento das demais estruturas do corpo. Objetivo: O estudo tem como objetivo mensurar as variações imediatas da resposta sintomática dolorosa por pressão na coluna lombar pela manipulação visceral. Métodos: Trata-se de um estudo experimental, com abordagem longitudinal e caráter quantitativo. Constituído por amostra de doze indivíduos divididos em G1 (uso de manipulação visceral), G2 (uso de placebo) e uso do algômetro de pressão nos músculos paravertebrais corresponde ao nível topográfico da quinta vértebra lombar. Para análise estatística dos dados obtidos, foi aplicado o teste t de Student para amostras pareadas no software Bioestat. Além disso, o nível de rejeição da hipótese de nulidade foi estabelecido em 0,05 ou 5%. Resultados: Obteve-se relevância em um ponto de vista estatístico na análise do grupo submetido a manipulação visceral. Quando comparado a outras evidências recentes, os resultados obtidos pelo estudo revelam dados condizentes. Conclusão: Os resultados deste estudo fornecem informações confiáveis que vão nortear a futura utilização da manipulação visceral na dor lombar crônica, mostrando bom prognóstico em curto prazo. (AU)

Introduction: Visceral manipulation is currently a treatment widely used by osteopaths worldwide, however, its basis of mechanisms is still poorly understood, and there is a lack of published research on such interventions. The concept for treatment is based on the action on fascia adhesions that supposedly affect visceral hemodynamics, autonomic dysregulation, psychosomatic factors, and visceral ptosis, directly affecting the proper functioning of other body structures. Objective: This study aimed to measure the immediate variations in the symptomatic painful response to pressure in the lumbar spine by visceral manipulation. Methods: This is an experimental study, with a longitudinal approach and quantitative character. Consisting of a sample of twelve individuals divided into G1 (use of visceral manipulation), G2 (use of placebo) and use of the pressure algometer in the paravertebral muscles corresponds to the topographic level of the fifth lumbar vertebra. For statistical analysis of the data obtained, the Student's t test was applied to paired samples using the Bioestat software. In addition, the level of rejection of the null hypothesis was set at 0.05 or 5%. Results: Relevance was obtained from a statistical point of view in the analysis of the groups submitted to visceral manipulation. When compared to other recent evidence, the results obtained by the study reveal consistent data. Conclusion: The results of this study provide reliable information that will guide the future use of visceral manipulation in chronic low back pain, showing a good prognosis in the short term. (AU)

Clinical effect of lever positioning manipulation for lumbar disc herniation and its influence on Cobb angle / 中国骨伤

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.

Curative effect of rotary dial up provided bonesetting combined with acupuncture method for treatment of mixed type cervical spondylosis / 新乡医学院学报

Objective To compare the curative effect of rotary dial up provided bonesetting combined with acupuncture method and acupuncture combined with oral medicine for treatment of mixed type cervical spondylosis.Methods Five hundred patients with mixed cervical spondylosis in the Department of Rehabilitation,the Chinese Medicine Hospital of Jiyuan from January 2015 to December 2016 were selected and divided into observation group (n =320) and control group (n =180).The patients in the observation group were treated with rotary dial up provided bonesetting combined with acupuncture method;the patients in the control group were treated with acupuncture and oral medicine.The curative effect of patients in the two groups was observed and analysed by ordered logistics regression.Results The effective rate of patients in the observation group (94.06％,301/320)was significantly higher than that in the control group (83.89％,151/180) (x2 =13.68,P ＜0.01).Ordinal logistics regression results showed that the regression coefficient of treatment methods was 1.38 and the curative effect of treatment group was better.The odds rate of exp(1.380) was 3.975,so effect advantage of the observation group was 3.975 times higher than the control group (P ＜ 0.05).Conclusion The curative effect of rotary dial up provided bonesetting combined with acupuncture method for treatment of mixed type cervical spondylosis is better than acupuncture combined with oral medicine.

Preventive Treatment of Cervical Cancer Patients with Postoperative Urinary Retention by Scalp-body Acupuncture Combined with Spine-manipulation Therapy / 广州中医药大学学报

Objective To observe the clinical effects and safety of scalp-body acupuncture and spine-manipulation therapy on preventively treating cervical cancer patients with postoperative urinary retention. Methods A total of 160 cases of cervical cancer patients with postoperative urinary retention were randomized into treatment group and control group, 80 cases in each group. Both groups were given conventional western medical treatment including preoperative indwelling of urethral catheter, clamping of urethral catheter 5 d after operation and release of the urine every 2-3 h, and trying to remove the urethral catheter 10-12 d after operation. Additionally, the treatment group received scalp acupuncture in the foot motor sensory area, body acupuncture of bilateral Shenshu (BL23) , Pangguangshu (BL28) , Ciliao (BL32) acupoints, and spine-manipulation therapy 5 d after operation. The clinical outcomes covered the incidence of urinary retention, residual urine volume, reset rate of catheter, and the clinical effect and safety in the two groups were evaluated. Results ( 1) The therapeutic effect of the treatment group was superior to that of the control group, and then the difference was significant (P<0.05). (2) After treatment, the incidence of urinary retention, residual urine volume, reset rate of catheter and average hospitalization days were less in the treatment group than those in the control group, the differences being significant ( P<0.05). ( 3) There was no adverse reaction during the treatment course. Conclusion Scalp acupuncture in the foot motor sensory area combined with body acupuncture and spine-manipulation therapy can promote the recovery of micturation function, and have satisfactory clinical effect and high safety in preventively treating cervical cancer with postoperative urinary retention.

Cerebrovascular accidents associated with cervical vertebra manipulation therapy / 中国康复理论与实践

@#ObjectiveTo describe 64 cases of cerebrovascular accidents temporally associated with cervical vertebra manipulation therapy in terms of patients' characteristics, potential risk factors, nature of complication, and neurologic sequelae.MethodsThree researchers using a uniform data abstraction instrument performed an independent review of 64 previously medicine records describing cerebrovascular ischemia after cervical vertebra manipulation. Descriptive statistics were calculated for characteristics of the patients and the complications. Means and standard deviations were computed for continuous variables. Frequencies were computed for continuous variables. Frequencies and proportions were calculated for categorical variables.ResultsProposed risk factors include age, gender, migraine headaches, hypertension, diabetes, birth control pills, cervical spondylosis, and smoking. It was unable to identify factors from the clinical history and physical examination of the patient that would assist a physician attempting to isolate the patient at risk of cerebral ischemia after cervical manipulation.ConclusionsCerebrovascular accident after manipulation appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach.