The immediate effect of cervical rotation-traction manipulation on cervical paravertebral soft tissue: a study using soft tissue tension cloud chart technology.

BACKGROUND: To evaluate the reliability of the Soft Tissue Tension Cloud Chart (STTCC) technology, an original method combining multi-point Cervical Paravertebral Soft Tissue Test (CPSTT) with MATLAB software, we conducted a preliminary analysis on the immediate effects of Orthopaedic Manual Therapy (OMT) on cervical paravertebral soft tissue. METHODS: 30 patients with Cervical Spondylotic Radiculopathy (CSR) were included in this study. We analyzed the differences in CPSTT before and after treatment with Cervical Rotation-Traction Manipulation (CRTM), a representative OMT technique in Traditional Chinese Medicine, using the STTCC technology. RESULTS: The STTCC results demonstrated that post-treatment CPSTT levels in CSR patients were significantly lower than pre-treatment levels after application of CRTM, with a statistically significant difference (P < 0.001). Additionally, pre-treatment CPSTT levels on the symptomatic side (with radicular pain or numbness) were higher across the C5 to C7 vertebrae compared to the asymptomatic side (without symptoms) (P < 0.001). However, this difference disappeared after CRTM treatment (P = 0.231). CONCLUSIONS: The STTCC technology represents a reliable method for analyzing the immediate effects of OMT. CSR patients display uneven distribution of CPSTT characterized by higher tension on the symptomatic side. CRTM not only reduces overall cervical soft tissue tension in CSR patients, but can also balance the asymmetrical tension between the symptomatic and asymptomatic sides. TRIAL REGISTRATION: This study was approved by the Chinese Clinical Trials Registry (Website: . https://www.chictr.org.cn .) on 20/04/2021 and the Registration Number is ChiCTR2100045648.

Comparison between Manual Traction, Manual Opening technique and Combination in Patients with cervical radiculopathy: Randomized Control Trial.

OBJECTIVE: To compare the effects of manual traction, manual intervertebral foramen opening technique and combination of the two techniques in patients with cervical radiculopathy. METHODS: The single-blind randomised control trial was conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan, from July 2017 to January 2018, and comprised patients of either gender having unilateral upper extremity pain, paresthesia or numbness. The subjects were placed into groups I, II and III using sealed envelope method. Group I was treated with the opening of intervertebral foramen technique, while group II received manual traction of cervical spine, and group III received both techniques. Three sessions were conducted per week for 3 weeks. The outcome measures were neck disability index, Numeric pain rating scale, patient-specific functional scale, and range of motions of cervical spine. SPSS 21 was used for data analysis. RESULTS: Of the 40 patients, 17(30%) were males and 23(70%) were females. There were 13(32.5%)patients each in groups I and II, while group III had 14(35%). Mean age in group I was 42.41±6.86 years, in group II 40.95±7 .32 years and in group III 42.50±5.77 years. There was no statisticallysignificant difference among the three groups with respect to any parameter (p>0.05). Individual group analysis showed significant improvement (p<0.05) in all parameters . CONCLUSIONS: Manual intervertebral foramen opening technique, manual traction, and combination of both techniques were equally effective in decreasing pain, level of disability and improved cervical mobility in patients with cervical radiculopathy.

Intraoperative Traction May Be a Viable Alternative to Anterior Surgery in Cerebral Palsy Scoliosis ≥100 Degrees.

BACKGROUND: For large scoliosis, 2 strategies to maximize correction include intraoperative traction and/or anterior release. It is unclear which patients will benefit the most form either approach. The purpose of our study is to compare the radiographic, perioperative clinical outcomes, and health-related quality of life (HRQoL) outcomes of 2 approaches when used in severe neuromuscular scoliosis in the setting of cerebral palsy (CP). METHODS: In total, 23 patients with minimum 2-year follow-up, major curves ≥100 degrees, and in whom treatment included posterior spinal fusion were evaluated. Eighteen were treated with posterior spinal fusion with intraoperative traction and 5 with anterior/posterior spinal fusion (APSF). The baseline characteristics, perioperative outcomes, and preoperative and 2-year follow-up data for HRQoL and radiographic measures were compared. RESULTS: The groups had similar age, sex, nutritional and seizure status, GMFCS level, and change in CPCHILD scores. The groups had similar curve magnitude (120 vs. 105 degrees, P=0.330) and flexibility (28% vs. 40%, P=0.090), but the APSF group had less pelvic obliquity (POB) (24 vs. 42 degrees, P=0.009). There were similar postoperative major curves (37 vs. 40 degrees, P=0.350), but greater correction in POB (33.5 vs. 14 degrees of correction, P=0.007) in the traction group. The APSF group had longer anesthesia times (669 vs. 415 min, P=0.005), but similar hospital stays, intensive care unit and days intubated, estimated blood loss, cell saver, and red blood cells used. Although the APSF group had twice the rate of complications (22% vs. 40%) during the first 90 days postoperatively, this did not reach statistical significance. CONCLUSIONS: Both intraoperative traction and anterior surgery were used to aid correction in severe CP scoliosis. Anterior surgery did not offer superior correction or better HRQoL, and was associated with increased operative times, whereas intraoperative traction was associated with greater correction of POB. Intraoperative traction may be a viable alternative to an anterior release in severe CP scoliosis. LEVEL OF EVIDENCE: Level II.

Asymmetry of activation of lateral abdominal muscles during the neurodevelopmental traction technique.

OBJECTIVE: The aim of the study was to evaluate the symmetry and pattern of activation of lateral abdominal muscles (LAM) in response to neurodevelopmental traction technique. DESIGN AND PARTICIPANTS: Measurements of LAM thickness were performed in four experimental conditions: during traction with the force of 5% body weight (5% traction): 1) in neutral position, 2) in 20° posterior trunk inclination; during traction with the force of 15% body weight (15% traction): 3) in neutral position, 4) in 20° posterior trunk inclination. Thirty-seven healthy children participated in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To evaluate LAM activation level ultrasound technology was employed (two Mindray DP660 devices (Mindray, Shenzhen, China) with 75L38EA linear probes). An experiment with repeated measurements of the dependent variables was conducted. RESULTS: Side-to-side LAM activation asymmetry showed relatively high magnitude, however, significant difference was found only in case of the obliquus externus (OE) during stronger traction (P < 0.05). The magnitude of LAM thickness change formed a gradient, with the most profound transversus abdominis (TrA) showing the smallest change, and the most superficial OE - the greatest. The inter-muscle differences were most pronounced between the OE and TrA (P < 0.001). CONCLUSIONS: During the neurodevelopmental traction technique there is a difference in individual LAM activation level, with deeper muscles showing less intense activation. In statistical terms, the only signs of side-to-side asymmetry of LAM activation are visible in case of the OE, however, the magnitude of asymmetry is relatively high. The results allow to identify patterns of activation of LAM in children showing typical development that will serve as a reference in future studies in children with neurological disorder.

[Application of convolute manipulation for the treatment of femoral fractures in children].

OBJECTIVE: To discuss the application of convoluted manipulation in pediatric femoral fractures. METHODS: From March 2015 to October 2016, 12 children with femoral fractures were treated by Chinese traditional manipulation including 8 males and 4 females with an average age of 6 years old ranging from 1 to 12 years old. The causes of injury were falls in 10 cases and traffic accidents in 2 cases. Of which 1 case was transverse fractures, 4 cases were oblique fractures and 4 cases were spiral fractures, 2 cases were comminuted fracture, 1 case was greenstick fracture. All patients underwent manual reduction within 1 to 2 days, plus small splint with cedar bark, and parallel lower limb traction. RESULTS: All the 12 patients were followed up for 1-3 months, with an average of 2 months. All the 12 patients achieved clinical union, and the average healing time was 6 weeks. There was no obvious shortening and rotational angulation. At the last follow-up, Schatzker-Lambert distal femoral fracture evaluation results were excellent in 11 cases, good in 1 case. CONCLUSIONS: Convoluted manipulation is very important for reduction of femoral fractures in children, with the splint of cedar bark, satisfactory therapeutic effect can be achieved.

The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study.

BACKGROUND: Cervicogenic dizziness is a disabling condition commonly associated with cervical dysfunction. Although the growing interest with the importance of normal sagittal configuration of cervical spine, the missing component in the management of cervicogenic dizziness might be altered structural alignment of the cervical spinal region itself. AIM: To investigate the immediate and long-term effects of a 1-year multimodal program, with the addition of cervical lordosis restoration and anterior head translation (AHT) correction, on the severity of dizziness, disability, cervicocephalic kinesthetic sensibility, and cervical pain in patients with cervicogenic dizziness. DESIGN: A randomized controlled study with a 1 year and 10 weeks' follow-up. SETTING: University research laboratory. POPULATION: Seventy-two patients (25 female) between 40 and 55 years with cervicogenic dizziness, a definite hypolordotic cervical spine and AHT posture were randomly assigned to the control or an experimental group. METHODS: Both groups received the multimodal program; additionally, the experimental group received the Denneroll™ cervical traction. Outcome measures included AHT distance, cervical lordosis, dizziness handicap inventory (DHI), severity of dizziness, dizziness frequency, head repositioning accuracy (HRA) and cervical pain. Measures were assessed at three time intervals: baseline, 10 weeks, and follow-up at 1 year and 10 weeks. RESULTS: Significant group × time effects at both the 10 week post treatment and the 1-year follow-up were identified favoring the experimental group for measures of cervical lordosis (P<0.0005) and anterior head translation (P<0.0005). At 10 weeks, the between group analysis showed equal improvements in dizziness outcome measures, pain intensity, and HRA; DHI scale (P=0.5), severity of dizziness (P=0.2), dizziness frequency (P=0.09), HRA (P=0.1) and neck pain (P=0.3). At 1-year follow-up, the between-group analysis identified statistically significant differences for all of the measured variables including anterior head translation (2.4 cm [-2.3;-1.8], P<0.0005), cervical lordosis (-14.4° [-11.6;-8.3], P<0.0005), dizziness handicap inventory (29.9 [-34.4;-29.9], P<0.0005), severity of dizziness (5.4 [-5.9;-4.9], P<0.0005), dizziness frequency (2.6 [-3.1;-2.5], P<0.0005), HRA for right rotation (2.8 [-3.9;-3.3], P<0.005), HRA for left rotation (3.1 [-3.5;-3.4, P<0.0005], neck pain (4.97 [-5.3;-4.3], P<0.0005); indicating greater improvements in the experimental group. CONCLUSIONS: The addition of Denneroll™ cervical extension traction to a multimodal program positively affected pain, cervicocephalic kinesthetic sensibility, dizziness management outcomes at long-term follow-up. CLINICAL REHABILITATION IMPACT: Appropriate physical therapy rehabilitation for cervicogenic dizziness should include structural rehabilitation of the cervical spine (lordosis and head posture correction), as it might to lead greater and longer lasting improved function.

Correction of Grade 2 Spondylolisthesis Following a Non-Surgical Structural Spinal Rehabilitation Protocol Using Lumbar Traction: A Case Study and Selective Review of Literature.

OBJECTIVE: Discuss the use of non-surgical spinal rehabilitation protocol in the case of a 69-year-old female with a grade 2 spondylolisthesis. A selective literature review and discussion are provided. CLINICAL FEATURES: A 69-year-old female presented with moderate low back pain (7/10 pain) and severe leg cramping (7/10 pain). Initial lateral lumbar x-ray revealed a grade 2 spondylolisthesis at L4-L5 measuring 13.3 mm. INTERVENTIONS AND OUTCOMES: The patient completed 60 sessions of Mirror Image® spinal exercises, adjustments, and traction over 45 weeks. Post-treatment lateral lumbar x-ray showed a decrease in translation of L4-L5 from 13.3 mm to 2.4 mm, within normal limits. CONCLUSIONS: This case provides the first documented evidence of a non-surgical or chiropractic treatment, specifically Chiropractic BioPhysics®, protocols of lumbar spondylolisthesis where spinal alignment was corrected. Additional research is needed to investigate the clinical implications and treatment methods.

[Randomized controlled trials of needle knife therapy combined with rotation traction manipulation for the treatment of cervical spondylotic radiculopathy].

OBJECTIVE: To compare the therapeutic effects between needle knife therapy combined with rotation traction manipulation and rotation traction manipulation for the treatment of cervical spondylotic radiculopathy. METHODS: From November 2013 to June 2015, 80 patients with cervical spondylotic radiculopathy meeting the inclusion criteria were divided into two groups randomly:the control group in which 39 patients were treated with rotation traction manipulation, and the treatment group in which 41 patients were treated with needle knife combined with rotation traction manipulation. The patients in the control group were treated once dayly for 2 weeks, which was 1 course. The patients in the treatment group were treated with needle knife firstly once a week for 2 weeks, which was 1 course;then were treated with the same methods as the patients in the control group. The symptoms, signs score and the therapeutic effects of the two groups before and after treatment were observed. RESULTS: After treatment, symptoms and signs scores declined in both groups(P<0.05). The results of the treatment group were better than effects in the control group(P<0.05). In the treatment group, 19 patients got an excellent result, 16 good, 5 fair and 1 bad;while in the control group, 10 patients got an excellent result, 10 good, 16 fair and 3 bad;the results of the treatment group were better than the results of the control group(P<0.01). CONCLUSIONS: Needle knife combined with rotation traction manipulation is an effective method for the treatment of cervical spondylotic radiculopathy, which is better than using manipulation method simply. Needle knife therapy has follow advantages:improving local blood circulation, reducing local content of pain substance, increasing production of substances resisting pain, opening channels and collaterals, and make body reaching new static and dynamic balance on the new foundation.

Richard's back: death, scoliosis and myth making.

The body of a mediaeval monarch was always under scrutiny, and Richard III's was no exception. In death, however, his body became subject to new forms of examination and interpretation: stripped naked after the battle of Bosworth, his corpse was carried to Leicester and exhibited before being buried. In 2012, it was rediscovered. The revelation that Richard suffered from scoliosis prompts this article to re-evaluate the historical sources about Richard's physique and his posthumous reputation. This article argues that Richard's death and his myth as 'crookback' are inextricably linked and traces attitudes to spinal curvature in the early modern period. It also considers how Shakespeare represented Richard as deformed, and aspects of performance history which suggest physical vulnerability. It then considers Richard's scoliosis from the perspective of medical history, reviewing classical accounts of scoliosis and arguing that Richard was probably treated with a mixture of axial traction and pressure. It demonstrates from the evidence of Richard's medical household that he was well placed to receive hands-on therapies and considers in particular the role of his physician and surgeon, William Hobbes. Finally, it shows how the case of Richard III demonstrates the close relationship between politics and medicine in the period and the contorted process of historical myth making.

[Acupuncture combined with traction therapy for lumbar disc herniation: a systematic review].

To evaluate the efficacy and safety of acupuncture combined with traction therapy for lumbar disc herniation, providing the basis for future research strategies. Randomized control trials. (RCT) of acupuncture combined with traction therapy for lumber disc herniation at home and abroad from 2000 to 2013 were searched, analysis and evaluation of literature and strength of evidence were based on the principles and methods of Evidence-based Medicine. The total effective rate and curative rate were considered as primary outcome measures; pain improvement, quality of life, relapse rate and adverse effects were considered as secondary outcome measures. Seventeen RCTs were identified, Meta-analysis showed that (1) total effective rate and curative rate: acupuncture combined with traction therapy was better than single therapy (acupuncture or traction); (2) pain improvement: acupuncture combined with traction therapy was better than traction therapy; (3) relapse rate: current evidence could not support the conclusion that acupuncture combined with traction therapy was better than traction therapy. Acupuncture combined with traction therapy for lumbar disc herniation was effective. However, the included studies were with high risk of bias, important outcome measures such as quality of life, relapse rate and adverse effects were not found in most of the studies. Current evidence has not yet been able to fully reflect acupuncture combined with traction therapy for lumbar disc herniation is better than single therapy, so more RCTs of higher quality are needed to further confirm its efficacy and safety.

[Effectiveness of manual therapy and traction for lumbar disc herniation: a meta-analysis].

OBJECTIVE: To evaluate the effectiveness of manual therapy and traction for lumbar disc herniation and analyze the current status of this kind of randomized clinical trial (RCT). METHODS: Database of CNKI, VIP, WANFANG, PubMed and OVID were searched. Some relevant journals were manually retrieved. A total of 2 874 literatures on manual therapy and traction for lumbar disc herniation were collected, of which 17 articles met the inclusion criteria. The Jadad score scale was used to evaluate the quality,and RevMan5.0 was used for meta-analysis of literatures. RESULTS: The results of the meta-analysis of all trials involved were as followed:the combined effect of the effective rate was RR = 1.10, 95% CI [1.06, 1.14], the combined effect of the cure rate was RR = 1.36, 95% CI [1.21,1.52], the combined effect of the VAS was RR = 1.37, 95% CI [1.28, 1.45], the combined effect of the JOA was RR = 4.75, 95% CI [4.40, 5.09]. CONCLUSION: The overall quality of the current RCT researches about manual therapy for lumbar disc herniation was lower,and did not support the conclusion that manual therapy was more effective than traction for lumbar disc herniation.

Effectiveness of mechanical traction as a non-surgical treatment for carpal tunnel syndrome compared to care as usual: study protocol for a randomized controlled trial.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition (prevalence of 4%) where the median nerve is compressed within the carpal tunnel resulting in numbness, tingling, and pain in the hand. Current non-surgical treatment options (oral medication, corticosteroid injections, splinting, exercise, and mobilization) show limited effects, especially in the long-term. Carpal tunnel release (CTR) surgery is effective in 70 to 75% of patients, but is relatively invasive and can be accompanied by complications. In an observational study, mechanical traction proved to be effective in up to 70% of patients directly after treatment and in 60% after two years follow-up. This randomized controlled trial (RCT) will examine the effectiveness of mechanical traction compared to care as usual in CTS. METHODS/DESIGN: Patients diagnosed with CTS will be recruited from an outpatient neurology clinic and randomly assigned to the intervention group (mechanical traction) or the control group (care as usual). Participants in the intervention group will receive 12 treatments with mechanical traction during six consecutive weeks. Primary outcome is symptom severity and functional status, which are measured with the Boston Carpel Tunnel Questionnaire (BCTQ). Secondary outcomes are quality of life (WHOQOL-BREF), health related resource utilization, and absenteeism from work. Outcomes will be assessed at baseline, and at 3, 6, and 12 months after inclusion. Linear mixed effect models will be used to determine the change from baseline at 12 months on the BCTQ, WHOQOL-BREF, absenteeism from work and health related resource utilization. The baseline measurement, change from baseline at three and six months, as well as duration of symptoms until inclusion, age, gender, and co-morbidity will be included as covariates The Pearson's correlation coefficient will be generated to assess the correlation between depression and anxiety and treatment outcome. DISCUSSION: Since current non-surgical treatment options are not effective long-term and CTR is relatively invasive, there is a need for an effective and non-invasive treatment option. Mechanical traction is a safe treatment option that may provide a good alternative for the usual care. Considering the prevalence of CTS, the study is of great clinical value to a large patient population. TRIAL REGISTRATION: Clinical Trials NL44692.008.13 (registered on 19 September 2013).

Effects of intermittent traction therapy in an experimental spinal column model.

Traction therapy, which is known to be a treatment method for scoliosis, one of many muscles disease, has been used since Hippocrates introduced it. However, the effects of traction therapy are still not clear. In addition, the meridian sinew theory, which is related to muscle treatment and is mentioned in the book on meridian sinews in the Miraculous Pivot of Huangdi's Internal Classic, has not been the subject of much study. For these reasons, experimental spinal models were made for this study to observe and analyze the lengths of vertebral interspaces after intermittent traction therapy, which is known to be excellent among muscle treatment methods, with various tensile forces. The results showed that the effects of intermittent traction therapy were unclear and that it might be harmful, especially when the pain was induced by muscle weakness. Because the results of this study on intermittent traction therapy were different from those expected from osteopathy or craniosacral theory, better studies of the subject are necessary.

Exercises for adolescent idiopathic scoliosis.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine . While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. The use of scoliosis-specific exercises (SSE) to reduce progression of AIS and postpone or avoid other more invasive treatments is controversial. OBJECTIVES: To evaluate the efficacy of SSE in adolescent patients with AIS. SEARCH METHODS: The following databases (up to 30 March 2011) were searched with no language limitations: CENTRAL (The Cochrane Library 2011, issue 2), MEDLINE (from January 1966), EMBASE (from January 1980), CINHAL (from January 1982), SportDiscus (from January 1975), PsycInfo (from January 1887), PEDro (from January 1929). We screened reference lists of articles and also conducted an extensive handsearch of grey literature. SELECTION CRITERIA: Randomised controlled trials and prospective cohort studies with a control group comparing exercises with no treatment, other treatment, surgery, and different types of exercises. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias and extracted data. MAIN RESULTS: Two studies (154 participants) were included. There is low quality evidence from one randomised controlled study that exercises as an adjunctive to other conservative treatments increase the efficacy of these treatments (thoracic curve reduced: mean difference (MD) 9.00, (95% confidence interval (CI) 5.47 to 12.53); lumbar curve reduced:MD 8.00, (95% CI 5.08 to 10.92)). There is very low quality evidence from a prospective controlled cohort study that scoliosis-specific exercises structured within an exercise programme can reduce brace prescription (risk ratio (RR) 0.24, (95% CI 0.06 to1.04) as compared to usual physiotherapy (many different kinds of general exercises according to the preferences of the single therapists within different facilities). AUTHORS' CONCLUSIONS: There is a lack of high quality evidence to recommend the use of SSE for AIS. One very low quality study suggested that these exercises may be more effective than electrostimulation, traction and postural training to avoid scoliosis progression, but better quality research needs to be conducted before the use of SSE can be recommended in clinical practice.

[Clinical study on curing the cervical spondylotic radiculopathy with the methods of Blade needle closed loosing and reduction with traction at the same time].

OBJECTIVE: To observe the effects of curing the cervical spondylotic radiculopathy with the methods of Blade needle closed loosing and reduction with traction at the same time. METHODS: From May 2006 to May 2009, 65 patients with cervical spondylotic radiculopathy were divided into treatment group and control group according the random number table produced by SAS Software. There were 18 males and 17 females in the treatment group,age in range from 42 to 73 years old with an average of (61.3 +/- 6.4) years, course of disease was from 8 to 42 months with an average of (23.8 +/- 13.8) months, preoperatively cervical functional score was from 4 to 17 scores with the mean of (11.45 +/- 3.31) scores. And in the control group, including 14 males and 16 females, aged from 44 to 76 years old with an average of (62.4 +/- 8.8) years, course of disease was from 7 to 43 months with an average of (24.4 +/- 16.8) months, preoperatively cervical functional score was from 4 to 18 scores with the mean of (11.40 +/- 3.24) scores. The patients of treatment group were treated with Blade needle closed loosing the specific pain point on the neck and shoulder, then immediately underwent traction and reduction after operation. And the patients of control group were treated with traditional traction. The cervical functional score were compared between the two groups at 10, 20, 180 d after treatment, including pain of neck and shoulder, limitation of motion of neck, tenderness of neck, numbness and muscle weakness of upper limb. RESULTS: (1) At the 10th day after treatment, the total score of treatment group was (15.43 +/- 3.46) scores, which was obviously higher than that of control group's (13.17 +/- 3.18) scores (P < 0.01). In different symptoms, treatment group also was better than that of control group (P < 0.05), so as in the tenderness of neck, and especially in the limitation of motion of neck and muscle weakness of upper limb decreased obviously (P < 0.01). (2) At the 20th day after treatment, the total score of treatment group was (18.00 +/- 2.94) scores, which was obviously better than that of control group's (15.90 +/- 2.89) scores (P < 0.01). In different symptoms, treatment group also was better than that of control group (P < 0.05), so as in the pain of neck and shoulder, numbness and muscle weakness of upper limb (P < 0.05), and especially in the limitation of motion of neck, tenderness of neck decreased obviously (P < 0.01). (3) At the 180th day after treatment, the total score of treatment group was (16.63 +/- 3.32) scores, which was obviously better than that of control group's (12.67 +/- 3.42) scores (P < 0.01); In different symptoms, treatment group also was better than that of control group (P < 0.05), so as in the numbness of upper limb (P < 0.05), and especially in the pain of neck and shoulder, muscle weakness of upper limb, limitation of motion of neck, tenderness of neck decreased obviously (P < 0.01). CONCLUSION: Compared with method of traditional traction, Blade needle closed loosing and traction in treating cervical spondylotic radiculopathy can significantly obtain clinical effects,which can quickly improve symptoms, relieve pain of neck and shoulder, limitation of motion of neck, tenderness of neck, numbness and muscle weakness of upper limb.

[A new reduction technique for posterior locked shoulder dislocation. Case report and technique description]. / Eine neue Repositionstechnik für die verhakte hintere Schulterluxation. Fallbericht und Beschreibung der Repositionstechnik.

The case of a 61-year-old male with posterior dislocation of the right shoulder joint is presented and a new technique for closed reduction of posterior locked shoulder dislocation is described. The technique involves four steps: in step 1 a constant traction is applied on the injured arm, in step 2 the arm is internally rotated and in steps 3 and 4 the second arm of the physician is used as a lever arm to lateralize and ventralize the shoulder. Lateralization and ventralization of the humeral head are essential to engage the humeral head and to pass it around the glenoid during reduction. Steps 3 and 4 are performed simultaneously. In the presented case the patient suffered a traumatic shoulder dislocation with a rim fracture of the glenoid. After reduction the shoulder was stable and conservative treatment was performed. A 2 year follow-up examination revealed a pain-free and stable shoulder with free range of motion and an Oxford instability score of 48 points. The described reduction technique for posterior locked shoulder dislocation is a simple and gentle technique, which can be performed easily by one person.Presentation of a reduction technique for locked posterior shoulder dislocation. Constant traction and internal rotation is performed for engaging the locked humeral head. After disengaging the humeral head the reduction is performed by using the arm of the physician as a lever arm.

The effect of Saunders traction and transcutaneous electrical nerve stimulation on the cervical spine range of motion in patients reporting neck pain - pilot study.

INTRODUCTION: It is estimated that about 80% of the general population occasionally experience spinal pain, with as many as 50% reporting pain in the cervical spine. The aim of this study was to determine the effectiveness of treatment of cervical spine pain with the Saunders traction device and transcutaneous electrical nerve stimulation (TENS) by assessing their impact on the cervical spine range of motion in the sagittal, coronal and horizontal planes. MATERIAL AND METHODS: A total of 39 patients aged 26 to 62 years took part in the study. All patients reported chronic cervical spine pain caused by overload and postural insufficiency. The participants were randomly divided into three experimental groups. The first group was treated with Saunders traction where the traction force was administered so that the patient would experience noticeable but painless traction. The second group received traction as well as classic transcutaneous electrical nerve stimulation, whereas the third group received only TENS. Each patient attended 10 treatment sessions not more than three days apart. Measurements of the range of motion were performed with the CROM instrument before and after the first session, after the fifth and tenth session and about three weeks after completion of rehabilitation. RESULTS: The study revealed the greatest ROM improvement in the coronal and horizontal planes and for the extension motion. CONCLUSIONS: The best therapeutic effect was obtained by combining traction with transcutaneous electrical nerve stimulation.

Immediate changes in spinal height and pain after aquatic vertical traction in patients with persistent low back symptoms: a crossover clinical trial.

OBJECTIVE: To investigate the effect of aquatic vertical traction on spinal height, pain intensity, and centralization response compared with a land-based supine flexion position for patients with low back pain and signs of nerve root compression. DESIGN: Single-blind, repeated-measures crossover design. SETTING: Outpatient physical therapy clinic. SUBJECTS: Ninety-eight subjects were recruited using consecutive sampling, with 28 men and 32 women of a mean ± standard deviation (SD) age of 59.6 ± 11.6 years completing testing. INTERVENTION: Each subject participated in 2 sessions that consisted of loaded walking for 15 minutes, followed by either 15 minutes of land-based supine position or 15 minutes of aquatic vertical traction. MEASUREMENTS: Spinal height change, measured using a commercial stadiometer, was determined after completing loaded walking and after each intervention. RESULTS: The mean ± SD height change of 4.99 ± 2.88 mm after aquatic vertical traction was similar to that of 4.21 ± 2.53 mm after the land-based supine flexion (P = .0969). Paired t-test indicated that both interventions resulted in significant increased height (P < .0001). Decreases in pain after aquatic intervention (2.7 ± 2.1 cm) were significantly greater than decreases after land intervention (1.7 ± 1.7 cm; P = .0034), and centralization of symptoms was more pronounced after aquatic vertical suspension compared with the supine land-based flexion condition (P < .0001). A significant correlation between height change and both pain reduction (r = 0.39; P = .001) and centralization (r = 0.29; P = .013) was observed for the aquatic intervention only. CONCLUSION: Although both the aquatic and land interventions produced significant increases in overall spinal height, the aquatic intervention produced greater pain relief and centralization response in subjects with low back pain and signs of nerve root compression.

Finite element analysis of weightbath hydrotraction treatment of degenerated lumbar spine segments in elastic phase.

3D finite element models of human lumbar functional spinal units (FSU) were used for numerical analysis of weightbath hydrotraction therapy (WHT) applied for treating degenerative diseases of the lumbar spine. Five grades of age-related degeneration were modeled by material properties. Tensile material parameters of discs were obtained by parameter identification based on in vivo measured elongations of lumbar segments during regular WHT, compressive material constants were obtained from the literature. It has been proved numerically that young adults of 40-45 years have the most deformable and vulnerable discs, while the stability of segments increases with further aging. The reasons were found by analyzing the separated contrasting effects of decreasing incompressibility and increasing hardening of nucleus, yielding non-monotonous functions of stresses and deformations in terms of aging and degeneration. WHT consists of indirect and direct traction phases. Discs show a bilinear material behaviour with higher resistance in indirect and smaller in direct traction phase. Consequently, although the direct traction load is only 6% of the indirect one, direct traction deformations are 15-90% of the indirect ones, depending on the grade of degeneration. Moreover, the ratio of direct stress relaxation remains equally about 6-8% only. Consequently, direct traction controlled by extra lead weights influences mostly the deformations being responsible for the nerve release; while the stress relaxation is influenced mainly by the indirect traction load coming from the removal of the compressive body weight and muscle forces in the water. A mildly degenerated disc in WHT shows 0.15mm direct, 0.45mm indirect and 0.6mm total extension; 0.2mm direct, 0.6mm indirect and 0.8mm total posterior contraction. A severely degenerated disc exhibits 0.05mm direct, 0.05mm indirect and 0.1mm total extension; 0.05mm direct, 0.25mm indirect and 0.3mm total posterior contraction. These deformations are related to the instant elastic phase of WHT that are doubled during the creep period of the treatment. The beneficial clinical impacts of WHT are still evident even 3 months later.

Propriedades mecânicas do gastrocnêmio eletroestimulado pós-imobilização / Mechanical properties of gastrocnemius eletrostimulated after immobilization

INTRODUÇÃO: As propriedades mecânicas (PM) consistem num instrumento de aplicabilidade clínica para profissionais de saúde que atuam no sistema músculo-esquelético. OBJETIVOS: Avaliar dois protocolos de estimulação elétrica neuromuscular (NMES) na potencialização do restabelecimento das PM no complexo músculo-tendíneo após imobilização segmentar de ratas. MATERIAIS E MÉTODOS: Foram utilizados 50 animais distribuídos em: Controle (GC, n=10); Imobilizado (GI, n=10); Imobilizado e remobilizado livre (GIL, n=10), Imobilizado e NMES uma vez ao dia (GIE1, n=10) e Imobilizado e NMES duas vezes ao dia (GIE2, n=10). A imobilização foi realizada por 14 dias. O GIL foi liberado posteriormente por 10 dias. A NMES foi aplicada pós-imobilização por 10 dias, GIE1 aplicado pela manhã (10 minutos) e, GIE2 aplicado pela manhã e à tarde (totalizando 20 minutos). Posteriormente, o músculo gastrocnêmio foi submetido ao ensaio mecânico de tração sendo as PM de rigidez, resiliência, carga e o alongamento no limite máximo avaliadas. RESULTADOS: A imobilização reduziu os valores das propriedades de carga e rigidez (p<0,05). A NMES utilizada duas vezes ao dia determinou resultados menos satisfatórios das PM avaliadas que àqueles obtidos uma vez ao dia e no grupo remobilizado (p>0,05). CONCLUSÃO: O músculo gastrocnênio tornou-se estruturalmente mais organizado frente à aplicação unitária da NMES e na remobilização.

INTRODUCTION: Mechanical properties (MP) are clinically applicable tools for healthcare professionals working on the musculoskeletal system. OBJECTIVES: The aim of this study was to evaluate two protocols of neuromuscular electric stimulation (NMES) to improve MP regeneration of the myotendinous complex after segment immobilization in female rats. MATERIALS AND METHODS: Fifty animals were equally distributed into five groups: Control (CG, n=10); Immobilized (IG, n=10); Immobilized and freely remobilized (IFG, n=10); Immobilized and NMES once /day (IEG1, n=10); Immobilized and MNES twice/day (IEG2, n=10). Immobilization was kept for 14 days, and remobilization was subsequently released for 10 days. NMES was applied for 10 days, post-immobilization, every morning for 10 minutes to IEG1 animals and every morning and afternoon (total 20 minutes) to the IEG2 group. After these procedures, the gastrocnemius muscle was submitted to the mechanical traction assay to evaluate stiffness, resilience, load and stretching at maximum limit MPs. RESULTS: Immobilization reduced the MP values concerning load and stiffness (p<0.05). Results for NMES applied twice a day were less satisfactory than the ones obtained with one application or in the remobilized group (p> 0.05). CONCLUSION: It is concluded that the gastrocnemius muscle became structurally better organized through a single NMES application and by remobilization.