Characterization of stimulus response curves obtained with transcranial magnetic stimulation from bilateral anterior digastric muscles in healthy subjects.

PURPOSE: The purpose of the study was to describe measurements of stimulus-response curves in the anterior digastric muscle (ADM) bilaterally following transcranial magnetic stimulation (TMS) to the right and left hemispheres. The first dorsal interosseous muscle (FDI) was the control muscle. MATERIALS AND METHODS: The subjects were 20 healthy young adults. Test sessions determined motor thresholds (MT) and stimulus-response curves (1.0, 1.2, 1.4, 1.6 × MT) from either the FDI or ADM following TMS to left and right hemispheres using the double cone coil. Bilateral recordings of MEPs in the left and right ADM allowed us to generate stimulus response curves following ipsilateral and contralateral TMS. RESULTS: Intraclass correlation coefficients (ICC) for MEP amplitudes from ipsilateral and contralateral ADMs were >0.60 at motor threshold (MT) and >0.90 at stimulus intensities above MT. There was a linear increase in MEP amplitudes across stimulus intensities for the FDI following contralateral TMS, while MEP amplitudes from the ADM following contralateral and ipsilateral TMS increased linearly across stimulus intensities [F(3, 57) [Muscle × Recording Site × Stim Intensity] = 33.57; p < 0.05]; (ηp2 = 0.64). The slopes of the stimulus-response curve of the contralateral FDI was greater than the slopes of the stimulus response curves of the ipsilateral and contralateral ADM (p < 0.05). CONCLUSIONS: The current study provided insights on the methodology for recording stimulus response curves in the ADM with TMS. These findings may translate into a valid, reliable, and relevant clinical outcome to study the pathophysiology of the corticobulbar motor system.

Changes in Opioid Therapy Use by an Interprofessional Primary Care Team: A Descriptive Study of Opioid Prescription Data.

OBJECTIVE: The purpose of this study was to describe changes in opioid-therapy prescription rates after a family medicine practice included on-site chiropractic services. METHODS: The study design was a retrospective analysis of opioid prescription data. The database included opioid prescriptions written for patients seeking care at the family medicine practice from April 2015 to September 2018. In June 2016, the practice reviewed and changed its opioid medication practices. In April 2017, the practice included on-site chiropractic services. Opiod-therapy use was defined as the average rate of opioid prescriptions over all medical providers at the practice. RESULTS: There was a significant decrease of 22% in the average monthly rate of opioid prescriptions after the inclusion of chiropractic services (F1,40 = 10.69; P < .05). There was a significant decrease of 32% in the prescribing rate of schedule II opioids after the inclusion of chiropractic services (F2,80 = 6.07 for the Group × Schedule interaction; P < .05). The likelihood of writing schedule II opioid prescriptions decreased by 27% after the inclusion of chiropractic services (odds ratio, 0.73; 95% confidence interval, 0.59-0.90). Changes in opioid medication practices by the medical providers included prescribing a schedule III or IV opioid rather than a schedule II opioid (F6,76 = 29.81; P < .05) and a 30% decrease in the daily doses of opioid prescriptions (odds ratio, 0.70; 95% confidence interval, 0.50-0.98). CONCLUSION: This study demonstrates that there were decreases in opioid-therapy prescribing rates after a family medicine practice included on-site chiropractic services. This suggests that inclusion of chiropractic services may have had a positive effect on prescribing behaviors of medical physicians, as they may have been able to offer their patients additional nonpharmaceutical options for pain management.

A comparison of student performance and satisfaction between a traditional and integrative approach to teaching an introductory radiology course on the extremities.

OBJECTIVE:: The purpose of the study was to compare student performance and student satisfaction ratings for an introductory extremities radiology course taught using 2 different educational methods. METHODS:: One group of students was taught using a traditional face-to-face instruction method, and the other group received an integrative blended-learning approach. A multivariate analysis of scores on lecture and laboratory examinations was performed to detect differences in student performance between the 2 methods. An independent t test was performed to compare the final course averages between the 2 methods. χ2 Analysis was used to compare the distribution of letter grades and levels of satisfaction between the 2 groups. RESULTS:: Test scores were higher for the integrative approach than for the traditional face-to-face method ( p < .05). However, the differences were not meaningful, as the greatest improvement in correct responses was only for 2 questions. Students appeared to be more satisfied with the integrative approach when compared to the traditional method ( p < .05). CONCLUSION:: Student satisfaction with the educational delivery methods in an introductory extremities radiology course using an integrative approach was greater than for the traditional face-to-face instruction method. Student performance was similar between the 2 cohorts.

Motor Neuron Excitability Attenuation as a Sequel to Lumbosacral Manipulation in Subacute Low Back Pain Patients and Asymptomatic Adults: A Cross-Sectional H-Reflex Study.

OBJECTIVE: The purpose of the study was to compare a time series of tibial nerve H-reflex trials between patients with subacute low back pain (LBP) and asymptomatic adults using pre and post high-velocity, low-amplitude (HVLA) spinal manipulation (SM) and control procedures. METHODS: Asymptomatic adults (n = 66) and patients with subacute LBP (n = 45) were randomized into 3 lumbosacral procedures: side-posture positioning, joint preloading with no thrust, and HVLA SM. A time series of 40 Hmax/Mmax ratios at a rate of 0.1 Hz were recorded in blocks of 10 trials at baseline and after the lumbosacral procedures at time points corresponding to immediately after, 5 minutes after, and 10 minutes after the procedure. Descriptive time series analysis techniques included time plots, outlier detection, and autocorrelation functions. A mixed analysis of variance model (group × procedure × time) was used to compare the effects of lumbosacral procedures on Hmax/Mmax ratios between the patients with subacute LBP and asymptomatic participants. RESULTS: The time series analysis and the significant lumbosacral × time interaction term (P < .05) indicated that inhibition of the Hmax/Mmax ratios at the 10-second postlumbosacral procedure time point was greatest after the HVLA SM procedure. The effects of lumbosacral procedures on Hmax/Mmax ratios were similar between patients with subacute LBP and asymptomatic participants. CONCLUSIONS: Although nonspecific effects of movement or position artifacts on the Hmax/Mmax ratio were present, a reliable and valid attenuation of the Hmax/Mmax ratio occurred as a specific aspect of HVLA SM in both asymptomatic adults and patients with subacute LBP.

The reliability of a novel magnetic resonance compatible electro-pneumatic device for delivering a painful pressure stimulus over the lumbar spine.

BACKGROUND: Chronic lower back pain (CLBP) is a significant public health problem in the USA. The complexity of CLBP necessitates an assessment tool that can objectively evaluate the aspects of CLBP that lead to disability. Here we present a novel means by which to provide pressure stimuli to the lumbar spine through the use of an electro-pneumatic circuit that can be used in conjunction with functional magnetic resonance imaging (fMRI) technology to assess the cortical activity changes associated with CLBP. METHODS: A test-retest experimental design was used to objectively quantify pressure pain sensitivity of the lumbar spine. Sensitivity was investigated through the identification of pressure pain thresholds of the lumbar spine using a multiple random staircase method (5-s stimuli) and continuous pain intensity rating (25-s stimuli). RESULTS: Data presented here were consistent and reliable from day to day with an interclass-correlation coefficient (ICC) value of 0.913 for threshold values overall and individual ICC values of 0.652, 0.818, and 0.851 for mild, moderate, and intense thresholds, respectively. Linear regression analysis for longer trials indicated a large variation on day 1, R(2) values ranged from 0.222 to 0.882, however, the number of low correlation values decreased with only three subjects having R(2) < 0.6 for trial 2 on day 2. CONCLUSION: This project has successfully developed a device that can deliver a reliable and reproducible stimulus over the lumbar spine that mimics the palpatory technique used in clinical practice, and can be used in conjunction with fMRI to assess cortical response.

Feasibility of using the patient-reported outcomes measurement information system in academic health centers: case series design on pain reduction after chiropractic care.

OBJECTIVE: The purpose of this study was to test the utility of Patient-Reported Outcomes Measurement Information System (PROMIS) as a resource for collecting data on patient-reported outcomes (PRO) within academic health centers at a chiropractic college; and, to describe changes in PRO following pragmatic chiropractic care incorporating instrument-assisted soft tissue mobilization (IASTM) on pain symptoms. METHODS: This was a pre-post intervention design without a control group (case series) involving 25 patients (14 females and 11 males; 40.5 ± 16.39 years, range 20-70 years) who completed their chiropractic care and their baseline and post-treatment pain assessments. The pragmatic chiropractic care intervention included both spinal manipulation and IASTM to treat pain symptoms. PRO's were collected using PROMIS to measure pain behavior, pain interference and pain intensity. RESULTS: The average pre-post assessment interval was 33 ± 22.5 days (95% CI, 23-42 days). The durations of treatments ranged from one week to 10 weeks. The median number of IASTM treatments was six. Pre-post decreases in T-scores for pain behavior and pain interference were 55.5 to 48.4 and 57.7 to 48.4, respectively (P < .05). Only 12 patients had a baseline T-score for pain intensity greater than 50. The pre-post decrease in pain intensity T-scores for these 12 patients was from 53.4 to 40.9. CONCLUSION: Within the limitations of a case series design, these data provide initial evidence on the utility of PROMIS instruments for clinical and research outcomes in chiropractic patients.

Changes in anthropometric measurements, body composition, blood pressure, lipid profile, and testosterone in patients participating in a low-energy dietary intervention.

OBJECTIVE: The purpose of this study was to describe changes in anthropometric measurements, body composition, blood pressure, lipid profile, and testosterone following a low-energy-density dietary intervention plus regimented supplementation program. METHODS: The study design was a pre-post intervention design without a control group. Normal participants were recruited from the faculty, staff, students, and community members from a chiropractic college to participate in a 21-day weight loss program. All participants (n = 49; 36 women, 13 men; 31 ± 10.3 years of age) received freshly prepared mostly vegan meals (breakfast, lunch, and dinner) that included 1200 to 1400 daily calories (5020.8 to 5857.6 J) for the women and 1600 to 1800 (6694.4 to 7531.2 J) daily calories for the men. Nutritional supplements containing enzymes that were intended to facilitate digestion, reduce cholesterol levels, increase metabolic rate, and mediate inflammatory processes were consumed 30 minutes before each meal. The regimented supplementation program included once-daily supplementation with a green drink that contained alfalfa, wheatgrass, apple cider vinegar, and fulvic acid throughout the study period. A cleanse supplementation containing magnesium, chia, flaxseed, lemon, camu camu, cat's claw, bentonite clay, tumeric, pau d'arco, chanca piedra, stevia, zeolite clay, slippery elm, garlic, ginger, peppermint, aloe, citrus bioflavonoids, and fulvic acid was added before each meal during week 2. During week 3, the cleanse supplementation was replaced with probiotic and prebiotic supplementation. RESULTS: Multiple paired t tests detected clinically meaningful reductions in weight (- 8.7 ± 5.54 lb) (- 3.9 ± 2.5 kg), total cholesterol (- 30.0 ± 29.77 mg/dL), and low-density lipoprotein cholesterol (- 21.0 ± 25.20 mg/dL) (P < .05). There was a pre-post intervention increase in testosterone for men (111.0 ± 121.13 ng/dL, P < .05). CONCLUSIONS: Weight loss and improvements in total cholesterol and low-density lipoprotein cholesterol levels occurred after a low-energy-density dietary intervention plus regimented supplementation program.

Using confidence-based marking in a laboratory setting: A tool for student self-assessment and learning.

OBJECTIVE: Confidence-based marking (CBM), developed by A. R. Gardner-Medwin et al., has been used for many years in the medical school setting as an assessment tool. Our study evaluates the use of CBM in the neuroanatomy laboratory setting, and its effectiveness as a tool for student self-assessment and learning. METHODS: The subjects were 224 students enrolled in Neuroscience I over a period of four trimesters. Regional neuroanatomy multiple choice question (MCQ) quizzes were administered the week following topic presentation in the laboratory. A total of six quizzes was administered during the trimester and the MCQ was paired with a confidence question, and the paired questions were scored using a three-level CBM scoring scheme. RESULTS: Spearman's rho correlation coefficients indicated that the number of correct answers was correlated highly with the CBM score (high, medium, low) for each topic. The χ2 analysis within each neuroscience topic detected that the distribution of students into low, medium, and high confidence levels was a function of number of correct answers on the quiz (p < .05). Pairwise comparisons of quiz performance with CBM score as the covariate detected that the student's level of understanding of course content was greatest for information related to spinal cord and medulla, and least for information related to midbrain and cerebrum. CONCLUSION: CBM is a reliable strategy for challenging students to think discriminately-based on their knowledge of material. The three-level CBM scoring scheme was a valid tool to assess student learning of core neuroanatomic topics regarding structure and function.

Understanding inhibitory mechanisms of lumbar spinal manipulation using H-reflex and F-wave responses: a methodological approach.

The purpose of this research was to characterize unique neurophysiologic events following a high velocity, low amplitude (HVLA) spinal manipulation (SM) procedure. Descriptive time series analysis techniques of time plots, outlier detection and autocorrelation functions were applied to time series of tibial nerve H-reflexes that were evoked at 10-s intervals from 100 s before the event until 100 s after three distinct events L5-S1 HVLA SM, or a L5-S1 joint pre-loading procedure, or the control condition. Sixty-six subjects were randomly assigned to three procedures, i.e., 22 time series per group. If the detection of outliers and correlograms revealed a pattern of non-randomness that was only time-locked to a single, specific event in the normalized time series, then an experimental effect would be inferred beyond the inherent variability of H-reflex responses. Tibial nerve F-wave responses were included to determine if any new information about central nervous function following a HVLA SM procedure could be ascertained. Time series analyses of H(max)/M(max) ratios, pre-post L5-S1 HVLA SM, substantiated the hypothesis that the specific aspects of the manipulative thrust lead to a greater attenuation of the H(max)/M(max) ratio as compared to the non-specific aspects related to the postural perturbation and joint pre-loading. The attenuation of the H(max)/M(max) ratio following the HVLA SM procedure was reliable and may hold promise as a translational tool to measure the consistency and accuracy of protocol implementation involving SM in clinical trials research. F-wave responses were not sensitive to mechanical perturbations of the lumbar spine.

Effects of foot orthotics on running economy: methodological considerations.

OBJECTIVE: The purpose of the study was to collect preliminary data to address methodological considerations that may impact subject-specific reactions to foot orthotics during running. METHODS: Six endurance-trained recreational runners recruited from a chiropractic college campus wore their preferred running shoes and then inserted either their custom-made orthotics during 1 testing session or their shoe-fitted insoles during the other testing session. Comfort perception was measured for each footwear condition. Measurements of oxygen consumption (VO2) at several moderate exercise intensities, to mimic recreational running, generated an individual's economy-of-running line. Predicted running velocity at VO(2max) (vVO2max) was calculated as an index of endurance performance. Lower extremity muscle activity was recorded. Descriptive statistics, a repeated-measures analysis of variance model, and a paired t test were used to document any systematic changes in running economy, lower extremity muscle activities, and vVO2max within and across subjects as a function of footwear conditions. RESULTS: Decreases in VO2 at several moderate exercise intensities (F((1,5)footwear) = 10.37, P = .023) and increases in vVO2max (t(5) = 4.20, P = .008) occurred in all 6 subjects while wearing their orthotic intervention vs their shoe-fitted insoles. There were no consistent changes in lower extremity muscle activity. CONCLUSIONS: Methodological decisions to use a sustained incremental exercise protocol at several moderate exercise intensities and to measure comfort perception of a custom-molded foot orthosis were effective at documenting systematic improvements in running economy among the 6 recreational runners tested. The development of a less physically demanding sustained exercise protocol is necessary to determine underlying neuromuscular mechanisms and/or clinical effectiveness of orthotic interventions.

Effects of footwear comfort perception on the neuromuscular control of balance.

The purpose of this research was to determine the effects of footwear comfort perception on the gain of the gastrocnemius H-reflex response during single leg balance tasks. Subjects performed single leg balance tasks while wearing aerobic sneakers with two different pairs of shoe insoles that were subjectively rated for comfort using a reliable 150 mm visual analog scale. The primary outcome was the consistency of decreasing the gain of the gastrocnemius H-reflex with increasing balance task complexity as a function of footwear comfort perception. Among the asymptomatic subjects (n = 11), H-reflex gain significantly decreased by 19% and 10% from balancing on a stable surface to an unstable surface for the shoe-brand and replacement insoles, respectively (p < .05). Among the subjects with musculoskeletal disorders (n = 13), H-reflex gain significantly decreased by 10% from balancing on a stable surface to an unstable surface when wearing custom-molded foot orthotics, but H-reflex gain significantly increased by 27% from balancing on a stable surface to an unstable surface when wearing replacement insoles (p < .05). Decreases in footwear comfort perception may negatively impact the attenuation of gastrocnemius H-reflex gain that contributes to the neuromuscular control of challenging balance tasks.

The reliability of the Associate Platinum digital foot scanner in measuring previously developed footprint characteristics: a technical note.

OBJECTIVE: An ink pad and paper, pressure-sensitive platforms, and photography have previously been used to collect footprint data used in clinical assessment. Digital scanners have been widely used more recently to collect such data. The purpose of this study was to evaluate the intra- and interrater reliability of a flatbed digital image scanning technology to capture footprint data. METHODS: This study used a repeated-measures design on 32 (16 male 16 female) healthy subjects. The following measured indices of footprint were recorded from 2-dimensional images of the plantar surface of the foot recorded with an Associate Platinum (Foot Levelers Inc, Roanoke, VA) digital foot scanner: Staheli index, Chippaux-Smirak index, arch angle, and arch index. Intraclass correlation coefficient (ICC) values were calculated to evaluate intrarater, interday, and interclinician reliability. RESULTS: The ICC values for intrarater reliability were greater than or equal to .817, indicating an excellent level of reproducibility in assessing the collected images. Analyses of variance revealed that there were no significant differences between raters for each index (P > .05). The ICC values also indicated excellent reliability (.881-.971) between days and clinicians in all but one of the indices of footprint, arch angle (.689), with good reliability between clinicians. The full-factorial analysis of variance model did not reveal any interaction effects (P > .05), which indicated that indices of footprint were not changing across days and clinicians. CONCLUSIONS: Scanning technology used in this study demonstrated good intra- and interrater reliability measurements of footprint indices, as demonstrated by high ICC values.

Effects of tea combined with high-protein meal replacement shakes on anthropometric measurements, lipid profiles, cellular biochemistry, neurochemistry, and microbial metabolism: a prospective observational study.

OBJECTIVE: The purpose of this study was to report preliminary data on the effects of tea and high-protein meal replacement shakes on weight loss, waist-to-hip ratios, and lipid profiles in healthy subjects. Secondary analyses of urine samples assessed pre-post changes in cellular biochemistry, neurochemistry, and microbial metabolism. METHODS: This study used a pre-post intervention design without a control group. Thirty healthy subjects (20-60 years of age; 23 women and 7 men) participated in a 28-day diet intervention program consisting of a cleansing day and 6 restricted diet days per week. On cleansing days, the subjects drank 4 oz of tea 4 times per day with a recommendation to drink at least 64 oz of filtered water. On the restricted diet days, the subjects drank 2 high-protein meal replacement shakes, consumed one 400- to 600-cal (1674.3-2511.5 joules) meal consisting of low-glycemic index foods, and drank at least 64 oz of filtered water. RESULTS: Multiple paired t tests detected reductions in weight (6.4 lb), waist (1.9 in), and hip (1.1 in) measurements and in total cholesterol (13.3 mg/dL) and low-density lipoprotein cholesterol (11.4 mg/dL) (P < .05). Multiple paired t tests detected significant increases in energy metabolism from carbohydrates and amino acids and concomitant increases in oxidative stress (P < .05). CONCLUSION: The data support the concept that a low-glycemic load diet intervention incorporating tea and high-protein meal replacement shakes may cause weight loss and improve lipid profiles. The significant physiologic changes from the urine samples did not reflect meaningful metabolic effects.

The effect of recovery time on strength performance following a high-intensity bench press workout in males and females.

PURPOSE: To determine the effects of training sessions, involving high-resistance, low-repetition bench press exercise, on strength recovery patterns, as a function of gender and training background. METHODS: The subjects were 12 athletes (6 males and 6 females) and age-matched college students of both genders (4 males and 4 females). The subjects completed a 3-wk resistance training program involving a bench press exercise, 3 d/wk, to become familiar with the testing procedure. After the completion of the resistance training program, the subjects, on three consecutive weeks, participated in two testing sessions per week, baseline session and recovery session. During the testing sessions, subjects performed five sets of the bench press exercise at 50% to 100% of perceived five repetition maximum (5-RM). Following the weekly baseline sessions, subjects rested during a 4-, 24-, or 48-h recovery period. Strength measurements were estimates of one repetition maximum (1-RM), using equivalent percentages for the number of repetitions completed by the subject at the perceived 5-RM effort of the bench press exercise. RESULTS: The full-factorial ANOVA model revealed a Gender by Recovery Period by Testing Session interaction effect, F(2, 32) = 10.65; P < .05. Among male subjects, decreases in estimated 1-RM were detected at the 4- and 24-h recovery times. There were no differences in muscle strength among the female subjects, regardless of recovery time. CONCLUSIONS: For bench press exercises, using different recovery times of 48 h for males and 4 h for females may optimize strength development as a function of gender.

Spinal manipulation impacts cervical spine movement and fitts' task performance: a single-blind randomized before-after trial.

OBJECTIVE: The objective of this study was to determine if active cervical range of motion (ROM) and Fitts' task movement time differences occurred after high-velocity low-amplitude cervical spinal manipulation (SM) across various indexes of difficulty. METHODS: A single-blind randomized before-after trial was performed in a motor performance laboratory. Fifteen volunteers (21-42 years) with asymptomatic palpable intervertebral motion restriction at the C1-C2 level were randomly assigned to an SM group or to a no-intervention (NI) group. A single episode of upper cervical manipulation was performed on the SM group. Active cervical ROM and movement time were measured pre and posttreatment in the SM group and compared to similar measurements in the NI group. RESULTS: In the SM group, active cervical ROM into rotation increased after the intervention (pre, 74.75 degrees +/- 7.63 degrees ; post, 78.50 degrees +/- 7.23 degrees ; t (7) = -3.07; P < .02). During the second trial, significant group differences were present in the SM group for movement time in direction congruent conditions (F((8,48)) = 2.83; P < .02; eta(p)(2) = .320) and direction incongruent conditions (F((8,48)) = 2.31; P < .05; eta(p)(2) = .278) but not for the NI group. CONCLUSIONS: A linear relationship between indexes of difficulty and movement time as predicted by Fitts' law was observed. Significant group effects indicate that SM not only increases cervical active ROM but also facilitates the performance of a cervical spine Fitts' task requiring rotation. This task may be used to quantify motor performance in clinically symptomatic populations with reduced ROM who are appropriate candidates for SM.

Motor-evoked potentials recorded from lumbar erector spinae muscles: a study of corticospinal excitability changes associated with spinal manipulation.

OBJECTIVE: The purpose of this study was to determine if high-velocity, low-amplitude spinal manipulation (SM) altered the effects of corticospinal excitability on motoneuron activity innervating the paraspinal muscles. In a previous study using transcranial magnetic stimulation (TMS), augmentation of motor-evoked potentials (MEPs) from the gastrocnemius muscle after lumbar SM was reported. To date, there is no known report of the effect of SM on paraspinal muscle excitability. METHODS: The experimental design was a prospective physiologic evaluation of the effects of SM on corticospinal excitability in asymptomatic subjects. The TMS-induced MEPs were recorded from relaxed lumbar erector spinae muscles of 72 asymptomatic subjects. The MEP amplitudes were evaluated pre-SM and post-SM or conditions involving prethrust positioning and joint loading or control. RESULTS: There was a transient increase in MEP amplitudes from the paraspinal muscles as a consequence of lumbar SM (F([6,414]) = 8.49; P < .05) without concomitant changes after prethrust positioning and joint loading or in control subjects (P > .05). These data findings were substantiated by a significant condition x time interaction term (F([12,414]) = 2.28; P < .05). CONCLUSIONS: These data suggest that there is a postsynaptic facilitation of alpha motoneurons and/or corticomotoneurons innervating paraspinal muscles as a consequence of SM. It appears that SM may offer unique sensory input to the excitability of the motor system as compared to prethrust positioning and joint loading and control conditions.

Prospective case series on the effects of lumbosacral manipulation on dysmenorrhea.

OBJECTIVE: The objective of this prospective case series was to collect preliminary data as to the effectiveness of a specific chiropractic technique, drop table method, in the treatment of primary dysmenorrhea. METHODS: Over a 4-week period, 16 females were screened for symptoms of primary dysmenorrhea and motion restrictions of the lumbosacral spine. Thirteen subjects were enrolled into the study. Bilateral and unilateral lumbosacral flexion and extension restrictions were treated using drop table manipulations 3 times during each of the 2 consecutive menstrual cycles. Before entering the study and at the end of each menstrual cycle, the subjects self-reported ratings of menstrual pain (abdominal, pelvic, and low back pain) and associated symptoms of primary dysmenorrhea using Numeric Pain Scale. Numeric Pain Scale ratings for menstrual pain were the primary outcome measures. RESULTS: The median age was 26 years, and the median self-reported duration of the symptoms was 12 years. At baseline, all subjects reported pain severity scores of 5 or higher for at least 2 of 3 anatomical sites: lower or general abdominal pain and/or lower back pain. Using the 95% confidence interval (CI) as an estimate, clinically meaningful changes (<5) in general abdominal pain and lower back pain were evident for most patients during the treatment phase, whereas for lower abdominal pain, the improvements were subject and cycle dependent. CONCLUSIONS: Menstrual pain associated with primary dysmenorrhea may be alleviated with treatment of motion segment restrictions of the lumbosacral spine with drop table technique.

Evaluation of the effect of postural perturbation on motoneuronal activity following various methods of lumbar spinal manipulation.

BACKGROUND AND CONTEXT: One basic physiologic response to spinal manipulation (SM) is a transient decrease in motoneuronal activity, as assessed by the Hoffmann reflex (H-reflex) technique. However, questions of appropriate control procedures when using the H-reflex technique to study the basic physiologic mechanisms of SM still exist. The identification of appropriate control procedures may allow us to better differentiate among the specific and nonspecific aspects of SM. PURPOSE: The purpose of the research was to determine the contributions of postural perturbations on the attenuation of motoneuronal activity following spinal manipulative thrusts and spinal joint preload procedures applied to the lumbar spine. STUDY DESIGN/SETTING: H/M(max) ratios, recorded from the gastrocnemius muscle, were measured before and after lumbar spinal procedures. The experimental designs for the laboratory data collection protocols were repeated measures and between-subjects. PATIENT SAMPLE: The subjects were asymptomatic, young, healthy volunteers. OUTCOME MEASURE: H/M(max) ratios recorded from the gastrocnemius muscle. METHODS: In Experiment 1, the administration of prone lumbar procedures involved either manual assist to more fully shear the lumbar zygapophyseal joints or no manual assist. One set of subjects (n=17) received assisted joint preload force and manipulation, whereas a second set of subjects (n=17) received unassisted joint preload force and manipulation. In a second laboratory experiment, one set of subjects (n=10) received a L5-S1 side-posture SM, whereas a second set of subjects (n=10) were just positioned into side-posture. RESULTS: There was a H/M(max) ratio attenuation of 18.2% after assisted spinal manipulation, whereas H/M(max) ratio attenuation was only 9.5% after unassisted spinal manipulation. Decreases of H/M(max) ratios by 8.5% and 7.5% were observed after assisted and unassisted joint preload forces, respectively. The amount of H/M(max) ratio attenuation was significantly greater immediately after the L5-S1 SM procedure (28.4%) as compared with a side-posture positioning maneuver (15.3%). CONCLUSION: SM may provide procedure-specific sensory input that appears to vary, based upon the various types of vertebral loading applied to the lumbar spine.

Autonomic nervous system function among individuals with acute musculoskeletal injury.

OBJECTIVE: To determine differences in peripheral and cardiovascular autonomic function between individuals with acute musculoskeletal injury (<1 week) and healthy controls. METHODS: Autonomic cardiovascular modulation, baroreceptor sensitivity, skin conductance, and peripheral skin temperature were obtained in 6 subjects with acute musculoskeletal injury and 6 age- and sex-matched controls. Power spectral analysis was performed on both beat-to-beat R-R intervals and continuous systolic blood pressure (SBP) peaks. Baroreceptor sensitivity was derived using both heart rate and blood pressure spectral analysis components. RESULTS: The SD of R-R intervals was significantly different for the acute injury group relative to controls (49.8 +/- 10.5 vs 76.8 +/- 12.7 ms; P < .01). Continuous SBP peaks and skin conductance (sympathetic vasomotor and sudomotor indices, respectively) were significantly higher (59.6 +/- 6.7 vs 23.8 +/- 6.4 mm Hg2 /Hz, and 3.87 +/- 1.04 vs 2.19 +/- 0.3 mhos; P < .01, respectively) and baroreceptor sensitivity lower (0.97 +/- 0.07 vs 1.10 +/- 0.08 mm Hg; P < .02) in the acute injury group compared with controls. Regression analysis revealed a significant relationship between skin conductance and continuous SBP peaks (r = 0.75; P < .01). CONCLUSIONS: These findings suggest that interaction between cutaneous and vasomotor sympathetic neurons in response to acute musculoskeletal injury, reflected as increased afferent input from sensitized nociceptors and other sensory neurons, results in alterations in autonomic function.

Effects of the homeopathic remedy arnica on attenuating symptoms of exercise-induced muscle soreness.

OBJECTIVE: To evaluate the clinical efficacy of Arnica at a high potency (200c), on moderating delayed onset muscle soreness and accompanying symptoms of muscle dysfunction. METHODS: Twenty subjects completed a maximal eccentric exercise protocol with the non-dominate elbow flexors to induce delayed onset muscle soreness. Either Arnica or placebo tablets were administered in a random, double- blinded fashion immediately after exercise and at 24 hours and 72 hours after exercise. Before exercise, immediately post-exercise, and at 24, 48, 72, and 96 hours post-exercise, assessments of delayed onset muscle soreness and muscle function included: 1) muscle soreness and functional impairment; 2) maximum voluntary contraction torque; 3) muscle swelling; and 4) range of motion tests to document spontaneous muscle shortening and muscle shortening ability. Blood samples drawn before exercise and at 24, 48, and 96 hours after exercise were used to measure muscle enzymes as indirect indices of muscle damage. RESULTS: Regardless of the intervention, the extent of delayed onset muscle soreness and elevations in muscle enzymes were similar on the days following the eccentric exercise protocol. The post-exercise time profiles of decreases in maximum voluntary contraction torque and muscle shortening ability and increases in muscle swelling and spontaneous muscle shortening were similar for each treatment intervention. CONCLUSIONS: The results of this study did not substantiate the clinical efficacy of Arnica at a high potency on moderating delayed onset muscle soreness and accompanying symptoms of muscle dysfunction. Despite the findings of this study, future investigations on the clinical efficacy of homeopathic interventions should consider incorporating research strategies that emphasize differential therapeutics for each patient rather than treating a specific disease or symptom complex, such as DOMS, with a single homeopathic remedy.