Forces measured during spinal manipulative procedures in two age groups.
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OBJECTIVE: Manipulation techniques have a prominent, yet controversial, role in the treatment of back pain. Their use varies widely between the professional groups and between individual therapists, with no accurate method of standardizing or quantifying the treatment administered. METHODS: An instrumented mobilization couch was developed to measure and characterize typical forces used during spinal manipulative therapy. The couch was used to measure the forces applied to the lumbar spine of 30 young healthy subjects during five mobilization techniques, and to a clinical sample of 31 patients, aged between 45 and 65 yr. RESULTS: The magnitudes of the mobilization forces were found to be similar for the young and the older groups. Median forces of 164 and 168 N, respectively, were recorded during a Grade III procedure. However, the forces applied to the older group exhibited a smaller amplitude and higher frequency of oscillation than those applied to the young group (P < 0.001). CONCLUSION: Objective measurements can be used to characterize manipulative forces for both evaluative and teaching purposes. (+info)
The effect of spinal instrumentation on lumbar intradiscal pressure.
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The purpose of this study was to investigate the effect of spinal instrumentation on the intradiscal pressure (IDP) within the fixed motion segment. In vitro biomechanical testing was performed in six single functional spinal units of fresh calf lumbar spines using a pressure needle transducer. Various loads were applied by a materials testing system device. In addition to intact spine (control), anterior spinal instrumentation (ASI) and pedicle screw fixation (PS) constructs, as well as destabilized spine were tested. Relative to the control, the destabilized spine tended to have an increased IDP; by 15% in axial compression and by 9-36% in flexion-extension. Compared to the control, PS decreased the IDP by 23% in axial loading and 51% in extension loading and increased it by 60% in flexion for each loading. ASI decreased the IDP by 32% in flexion and 1% in extension. Lateral bending produced symmetrical changes of IDP in the control and destabilized spine, but no change in the PS construct. The IDP of the ASI construct was decreased by 77% in ipsilateral bending and increased by 22% in contralateral bending. These results demonstrated that eccentric loading from the spinal instruments increased IDP and significant disc pressure may still exist despite an increase in motion segment stiffness after lumbar stabilization. (+info)
A comparison of osteopathic spinal manipulation with standard care for patients with low back pain.
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BACKGROUND: The effect of osteopathic manual therapy (i.e., spinal manipulation) in patients with chronic and subchronic back pain is largely unknown, and its use in such patients is controversial. Nevertheless, manual therapy is a frequently used method of treatment in this group of patients. METHODS: We performed a randomized, controlled trial that involved patients who had had back pain for at least three weeks but less than six months. We screened 1193 patients; 178 were found to be eligible and were randomly assigned to treatment groups; 23 of these patients subsequently dropped out of the study. The patients were treated either with one or more standard medical therapies (72 patients) or with osteopathic manual therapy (83 patients). We used a variety of outcome measures, including scores on the Roland-Morris and Oswestry questionnaires, a visual-analogue pain scale, and measurements of range of motion and straight-leg raising, to assess the results of treatment over a 12-week period. RESULTS: Patients in both groups improved during the 12 weeks. There was no statistically significant difference between the two groups in any of the primary outcome measures. The osteopathic-treatment group required significantly less medication (analgesics, antiinflammatory agents, and muscle relaxants) (P< 0.001) and used less physical therapy (0.2 percent vs. 2.6 percent, P<0.05). More than 90 percent of the patients in both groups were satisfied with their care. CONCLUSIONS: Osteopathic manual care and standard medical care had similar clinical results in patients with subacute low back pain. However, the use of medication was greater with standard care. (+info)
Refractory torticollis after a fall.
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Though multiple medical and psychiatric causes of torticollis have been described, cervical dystonias resulting from distant somatic dysfunctions have not. This article describes the treatment of a 62-year-old woman in whom refractory retrotorticollis of surmised pelvic etiology developed after a fall. Structurally, cervical dystonias have been addressed as problems that originate in the head and neck, but this limited view of the musculoskeletal component of torticollis may prevent physicians from directing osteopathic manipulative treatment to the underlying problem. (+info)
A 57-year-old male presented with a rare case of spontaneous vertebral arteriovenous fistula manifesting as radiculopathy of the right arm, subsequently associated with pulsating tinnitus and vascular bruit in the nape. He had a past history of chiropractic-induced vertebrobasilar infarction. Angiography showed a simple and direct fistula between the third segment of the right vertebral artery and the epidural veins at the C-1 level, where the artery runs backward above the arch of the C-1 just proximal to the penetration of the dura. The fistula was successfully obliterated by coil embolization, resulting in rapid improvement of the signs and symptoms. Mechanical compression to the nerve roots by the engorged epidural veins with arterial pressure was considered to be the major cause of radiculopathy. Vertebral artery dissection induced by chiropractic manipulation is most likely responsible for the development of the fistula. (+info)
Adverse effects of spinal manipulation.
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Guidelines on acute back pain recommend spinal manipulation, but some commentators express concern that the adverse effects are under-reported. Eleven chiropractors distributed questionnaires to 108 consecutive new patients aged > 18 years, enquiring about adverse effects one hour, one day and two days after spinal manipulation. The forms were to be completed anonymously. 80 questionnaires (74%) were returned, 68 suitable for analysis. 28 patients reported adverse effects at one hour after treatment, the most common of which were extra pain (14) and radiating pain (9). 8 had reactions beginning the morning after. No serious adverse effects were reported. The adverse reactions, recorded in 53% of respondents, are those to be expected from a treatment that entails initial discomfort. They need to be set against the long-term benefits of spinal manipulation. (+info)
Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation.
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This single-blind randomised clinical trial compared osteopathic manipulative treatment with chemonucleolysis (used as a control of known efficacy) for symptomatic lumbar disc herniation. Forty patients with sciatica due to this diagnosis (confirmed by imaging) were treated either by chemonucleolysis or manipulation. Outcomes (leg pain, back pain and self-reported disability) were measured at 2 weeks, 6 weeks and 12 months. The mean values for all outcomes improved in both groups. By 12 months, there was no statistically significant difference in outcome between the treatments, but manipulation produced a statistically significant greater improvement for back pain and disability in the first few weeks. A similar number from both groups required additional orthopaedic intervention; there were no serious complications. Crude cost analysis suggested an overall financial advantage from manipulation. Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis, it can be considered as an option for the treatment of symptomatic lumbar disc herniation, at least in the absence of clear indications for surgery. Further study into the value of manipulation at a more acute stage is warranted. (+info)
Galbreath technique: a manipulative treatment for otitis media revisited.
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Otitis media is a common disorder that results in numerous visits to the physician each year. Antimicrobials, antihistamines, steroids, and surgery have all been used to treat otitis media; however, the literature makes little mention of osteopathic manipulative treatment in this regard. This article describes a technique that was first described in 1929 by William Otis Galbreath, DO. By simple mandibular manipulation, the eustachian tube is made to open and close in a "pumping action" that allows the ear to drain accumulated fluid more effectively. Physicians can easily teach this procedure to parents for use at home. (+info)