[Short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures].

Objective To explore the short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures, and explore the quantification of traditional Chinese medicine manual reduction and personalized improvement of splinting. Methods The clinical data of 50 patients with AO type-A distal radius fractures, who received treatment at the outpatient department of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province, were retrospective analyzed. The patient cohort included 22 females and 28 males, with ages ranging from 25 to 75 years old. Among them, 27 cases presented with distal radius fractures on the left side, and 24 cases on the right side. The patients were categorized into two groups: treatment group (n=25) and control group(n=25). There were 13 males and 12 females in the treatment group, with an average age of (56.2±5.5) years old. Treatment approach for this group involved several steps. Initially, Mimics Research software was used to conduct comprehensive analysis of complete CT data from the affected limb, resulting in the creation of a three-dimensional model. Subsequently, 3D models of the bones and skin contours, stored as STL format files, were imported into the Materialise Magics 23.0 software for model processing and repair. This facilitated the simulation of reduction and recording of displacement data, effectively generating a "digital prescription" to guide and quantify traditional Chinese medicine manipulation procedures. Finally, a personalized 3D printed splint was applied for fixation treatment. There were 15 males and 10 females in the control group, with an average age of (53.32±5.28) years old. These patients were treated with manualreduction combined with traditional splinting. The clinical efficacy of the two groups was assessed in terms of fracture reduction quality, fracture healing time, Gartland-Werley wrist joint score and X-ray parameters (palminclination angle, ulnar deviation angle, radius height) at 6 weeks post-operatively. Results The treatment group exhibited a shorter duration for achieving clinical healing compared to the control group (P<0.05). Six weeks post-operatively, the treatment group demonstrated higher wrist joint function scores, and a higher proportion of excellent and good outcomes than the control group(P<0.05). The treatment group was superior to the control group in terms of imaging parameters 6 weeks post-operatively (P<0.05). Conclusion By quantifying skin contours through digital simulation prescription reduction, a personalized 3D printed splint is developed to effectively stabilize fractures, enhancing localized fixation while ensuring greater adherence, stability, and comfort. This innovative approach offers personalized treatment for AO type-A distal radius fractures and presents a novel, precise treatment strategy for consideration.

Effect of Using the Modified Milch Technique on Quality of Life in Patients with Anterior Dislocation of the Shoulder Joint.

Objective: To evaluate the effect of the Milch technique on quality of life (QoL) in patients with anterior dislocation of the shoulder joint. Methods: A total of 126 patients undergoing manual reduction for anterior dislocation of the shoulder in our hospital from January 2021 to January 2022 were prospectively enrolled in this study. The randomized number table method was used to divide patients into the study group (63 patients) and the control group (63 patients). The study group was treated with a modified Milch technique while the control group was treated with the Hippocratic method. Success rate and complications were compared to evaluate the effectiveness of manual reduction. Clinical assessment of shoulder function included the Constant-Murley Score and visual analog scale (VAS) before, during and after manual reduction. Results: The success rate of primary and secondary reduction in the study group was significantly higher than in the control group (87.30% vs 61.90, respectively; P = .001; 11.11% vs 25.40%, respectively; P = .038). The failure rate in the study group was significantly lower than in the control group (1.59% vs 12.70%, respectively; P = .015). The time required for reduction in the study and control groups was 58.87 ± 7.92 seconds and 93.09 ± 8.01 seconds, respectively; a significant difference (t = -24.113; P < .001). There was no statistically significant difference in VAS scores before and during reduction in the 2 groups. After reduction, VAS scores in the study group were significantly lower than in the control group (1.02 ± 0.01 vs 1.14 ± 0.26, respectively; P < .001). There were no significant differences in pain level, activities of daily living, joint range of motion or muscle strength between the 2 groups before and after reduction (P > .05). After reduction, health status, emotional function, mental health, physiological function, physiological function, physical pain, vitality and social function scores in the study group were significantly higher than in the control group (P < .05). There were 4 avulsion fractures and 2 humeral fractures in the control group; no complications occurred in the study group, with a significant difference (χ2 = 6.289; P = .012). Conclusion: The Milch technique can improve the QoL in patients with anterior dislocation of the shoulder, and the success rate of the reduction is high.

Effect of traditional Chinese manipulation on ankle sprains: A systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis was performed to evaluate the clinical efficacy and safety of traditional Chinese manipulation in treating ankle sprains. METHODS: Seven databases were searched from inception to July 2020. A meta-analysis of randomized controlled trials comparing traditional Chinese manipulation and other conservative therapy for ankle sprains was conducted. The Cochrane Handbook tool was applied to access the quality and risk of bias of each study. The meta-analysis was performed with Review Manager 5.3 software (Nordic Cochrane Centre, Copenhagen, Denmark). RESULTS: In total, 14 articles and 1112 patients were included. The total effective rate of ankle manipulation was much higher than that of other conservative therapy (risk ratio [RR], 1.23; 95% confidence interval [CI], 1.17-1.30; P < .00001). The Baird-Jackson score (RR, 10.14; 95% CI, 5.57-14.70; P < .0001), visual analog scale score (RR, -1.78; 95% CI, -3.14 to -0.43; P = .01), and American Orthopaedic Foot and Ankle Society ankle-hindfoot score (RR, 15.70; 95% CI, 12.72-18.68; P < .00001) were significantly lower in the manipulation group than in the control group. Further subgroup analysis showed that the visual analog scale score of the rotating-traction-poking manipulation was significantly lower than that of the control group (RRRTPM, -2.56; 95% CI, -4.54 to -0.58; P = .01), while there were no significant differences between the effects of other manipulations and the control group (RRother manipulation, -0.62; 95% CI, -1.52 to 0.28; P = .18). CONCLUSION: Traditional Chinese manipulation might have a better effect on ankle sprains than other types of conservative treatment. The rotating-traction-poking manipulation might achieve better effects than other manipulation techniques in terms of alleviating pain intensity. However, considering the overall high or unclear risk of bias, the evidence identified does not allow for a robust conclusion concerning the efficacy and safety of traditional Chinese manipulation for treating ankle sprains. High-quality randomized controlled trials are needed to confirm these findings.

A systematic review of pre-hospital shoulder reduction techniques for anterior shoulder dislocation and the effect on patient return to function.

PURPOSE: The majority of acute anterior shoulder dislocations are sustained during sports and wilderness activities. The management of acute dislocations in the pre-hospital setting is currently without guidelines based on the evidence. The study aims to assess the risk of acute complications in pre-hospital shoulder reduction and identify which pre-hospital reduction technique has the highest success rate in the published literature. METHODS: The involved databases were Allied and Complementary Medicine, CENTRAL, CINAHL, Cochrane Database of Systematic Reviews, Embase, Europe PMC, Ovid MEDLINE®, Pedro, Proquest, Trip, and World Health Organization International Clinical Trials Registry platform. Only original research of high methodological quality was included, which was defined by the recently developed assessment tool-assessing the methodological quality of published papers (AMQPP) and investigated the management of acute anterior shoulder dislocations in the pre-hospital setting. RESULTS: Two hundred and ninety-eight articles were identified and screened. A full text review was performed on 40 articles. Four articles published between 2015 and 2018 met the inclusion criteria. A total of 181 patients were included with the study duration ranging from 6 to 60 months. All studies reported zero immediate complication following pre-hospital reduction and there were no documented subsequent adverse events regardless of the technique used. Prompt resolution of neurological symptoms was observed following the early and successful pre-hospital reduction. First attempt success rate, when performed by skilled practitioners, ranged from 72.3% to 94.9%. CONCLUSION: Pre-hospital shoulder reduction appears to be a safe and feasible option when carried out with the appropriate expertise. A novel reduction technique adapted from the mountain medicine diploma course at the University of Paris North was found to have the highest first attempt reduction success rate of 94.9%. Other techniques described in the literature included Hippocratic, Stimson's, Counter-traction and external rotation with the success rates ranging from 54% to 71.7%.

Impact of Extremity Manipulation on Postural Sway Characteristics: A Preliminary, Randomized Crossover Study.

OBJECTIVE: Evaluate multisegmental postural sway after upper- vs lower-extremity manipulation. METHODS: Participants were healthy volunteers (aged 21-40 years). Upper- or lower-extremity manipulations were delivered in a randomized crossover design. Postural assessments were made pre-post manipulation, in floor and rocker board conditions. Analysis included traditional balance measures of pathlength and range and sample entropy (SampEn) to examine the temporal structure of sway of the head, trunk, and surface. RESULTS: No statistical changes in pathlength or sway range on the ground surface condition were observed. No increases in the amount of sway occurred in any condition. Chiropractic manipulation of either upper or lower extremities led to reductions in traditional measures of postural control on the rocker board. In the anteroposterior direction (sagittal plane), lower-extremity manipulation led to increased trunk SampEn while on the ground, and conversely a decreased SampEn while on the rocker board. In the mediolateral rocker board condition (frontal plane), manipulation elicited a change in SampEn that differed according to site of manipulation; upper-extremity manipulation increased SampEn, whereas lower-extremity manipulation reduced SampEn. CONCLUSION: Both upper- and lower-extremity manipulation influenced several measures of postural sway on both the ground and the rocker board. Lower-extremity manipulation improved the organization of sway at the trunk (anteroposterior direction) and the board (mediolateral direction). Given the reduction and reorganization of sway metrics seen in this study, we propose extending this line of research to the elderly who are at greatest risk of increased sway and falls.

Effects of Tibiofibular and Ankle Joint Manipulation on Hip Strength and Muscle Activation.

OBJECTIVES: The purpose of this study was to determine whether high-velocity, low-amplitude ankle region manipulations could increase force output and muscle activation of hip musculature in individuals with a history of ankle sprain and unilateral tensor fascia latae (TFL) weakness during muscle testing. METHODS: This investigation used a single-arm repeated measures design. Twenty-five participants' force outputs were tested at three time points (before manipulation, immediately after manipulation, and 48 hours after manipulation), and muscle activation of the rectus femoris, gluteus medius, and TFL was measured before and immediately after manipulation. Manipulations were applied to the talocrural, subtalar, proximal, and distal tibiofibular joints of the weaker limb. No contralateral manipulations were applied. Two-way repeated measures analysis of variance was used to compare maximal and average force production for each limb. In addition, paired t tests were used to compare muscle activation before and after manipulations. RESULTS: There was a significant limb × time interaction. The involved limb average force increased from before manipulation (65.7 N) to 48 hours after manipulation (77.8 N; P = .014), maximal force increased (76.9 N) 48 hours after manipulation (87.8 N; P = .030), and gluteus medius activation increased (9.8% maximum, 12.2% average) immediately after manipulation. No significant differences were found in the uninvolved limb. CONCLUSION: The results of this study suggest that high-velocity, low-amplitude ankle region manipulations might improve hip abductor strength in individuals with a history of ankle sprain and unilateral weakness during a TFL muscle test.

Treatment of Neck Pain With Myofascial Therapies: A Single Blind Randomized Controlled Trial.

OBJECTIVE: This study aimed to investigate the effects of myofascial release therapy vs a standard physical therapy program in patients with neck pain (NP). METHODS: This was a randomized controlled trial in which 54 participants with mechanical NP were randomly assigned into an experimental group (EG) or a comparison group (CG). The EG group (n = 27) received 5 therapy sessions of myofascial release therapy while the CG group (n = 27) received 10 sessions of massage, ultrasound therapy, and transcutaneous electric nerve stimulation over a 2-week period. Outcome measures were the numerical pain rating scale (NPRS), pressure pain thresholds (PPTs) and range of motion at the end of treatment and at 1-month follow-up. RESULTS: At 1-month follow-up, between-group differences in change scores were found in the NPRS (mean = -1.56, 95% confidence interval [CI] [-2.30 to -0.81]; P < .001), in the right thoracic PPT (mean = 0.35, 95% CI [0.03-0.66]; P = .031), and in both left (mean = 0.34, 95% CI [0.08-0.61]; P = .012) and right (mean = 0.29, 95% CI [0.04-0.54]; P = .026) suboccipital PPTs. The success rate was 63.0% in the CG and 92.6% in the EG. The number needed to treat was 3.38 (95% CI = 1.99-11.23). CONCLUSIONS: Myofascial release therapy could be better than a standard physical therapy program for improving pain and suboccipital PPTs in patients with NP. However, the difference between both treatments is less than the minimum detectable change of the NPRS.

Tibiofemoral joint mobilizations following total knee arthroplasty and manipulation under anesthesia.

STUDY DESIGN: Case report. BACKGROUND: The purpose of this case report is to describe the use of tibiofemoral joint mobilizations to improve knee flexion in a patient with arthrofibrosis following total knee arthroplasty (TKA) and failed manipulation under anesthesia (MUA). CASE DESCRIPTION: A 62-year-old female presented to physical therapy 15 days after TKA with full knee extension, 45 deg of active knee flexion, 48 deg of passive knee flexion, pain, and a Lower Extremity Functional Scale (LEFS) score of 28. INTERVENTIONS/OUTCOMES: A multimodal intervention strategy was used initially with minimal improvement in knee flexion. The patient was diagnosed with fibrosis and MUA was performed. Passive knee flexion was 80 deg before MUA and 75 deg after MUA. Focused grade III and IV tibiofemoral joint mobilizations were used after MUA. At discharge, the patient had 90 deg of active and 116 deg of passive knee flexion, no pain, and an LEFS score of 80. DISCUSSION: A conventional multimodal intervention approach was ineffective for a patient who developed arthrofibrosis following TKA. A focused intervention approach of grade III and IV tibiofemoral joint mobilizations improved knee flexion, pain, and function following TKA and failed MUA.

Force transmission between thoracic and cervical segments of the spine during prone-lying high-velocity low-amplitude spinal manipulation: A proof of principle for the concept of regional interdependence.

BACKGROUND: Regional interdependence is conceptually based on observations that applying manual therapy to a remote anatomical region has an effect in the area of the patient's primary complaint. The current model for regional interdependence depends on force transmissibility within the body. This investigation sought to determine transmissibility between forces applied to the thoracic spine during prone-lying high-velocity low-amplitude spinal manipulative therapy and the cervical spine. METHODS: A chiropractic treatment table was modified to allow (or disallow) translation of the headrest in the caudal-cephalad direction when unlocked (or locked). Prone-lying high-velocity low-amplitude spinal manipulative therapy was applied to the thoracic region of 9 healthy participants with the headrest in both configurations. Head and thorax kinematics and kinetics were measured at interfaces between participant and the external environment, which included the clinician's hands. Compressive forces at the cervicothoracic junction and angular kinematics of the cervical spine were derived. Ratios between the clinician-applied forces (input) and the cervical compressive force (output) were also determined. FINDINGS: The cervical spine extended during all high-velocity low-amplitude spinal manipulative therapy trials. Force input-to-output ratios exceeded 1 for high-velocity low-amplitude spinal manipulative therapy trials performed with the headrest in the locked configuration, which was greater than ratios for the unlocked configuration. INTERPRETATION: Forces imparted to thoracic spine during high-velocity low-amplitude spinal manipulative therapy were transmitted to the cervical spine, which provided a precursor for the regional interdependence model for manual therapy. Friction between the participant's face and the treatment table's head rest likely amplified cervical compressive forces.

Three-step Reduction Therapy of Integrated Chinese and Western Medicine for Thoracolumbar Burst Fracture.

Objective: To investigate and compare the efficacy of three-step reduction (TSR) therapy of integrated Chinese and Western Medicine and posterior open (PO) surgery for thoracolumbar burst fracture. Methods: We selected 60 patients diagnosed with thoracolumbar burst fracture and received treatment in our hospital from December 2014 to March 2017. According to randomized digital table, they were randomly divided into TSR and PO groups. VAS pain grade, Oswestry disability index, height of centrum front, Cobb's angle of spine, bleeding, and complication of internal fixation of the two groups were compared. Results: Postoperative reduction of injured centrum, regained volume of canalis vertebralis, volume of bleeding, and early functional rehabilitation of TSR group were better than that of PO groups (P < 0.05). Conclusion: Through three-step reduction combined pedicle screw fixation surgery, we can achieve satisfied reduction of thoracolumbar burst fracture, rebuild the height of centrum, recover the biomechanics function of spine, and reduce bleeding. Three-step reduction therapy is an effective therapy for thoracolumbar burst fracture.

Tool Use and Generalized Motor Programs: We All Are Natural Born Poly-Dexters.

For most people, human tool use is inextricably entwined with manual dexterity. This folk belief is widespread among scientists too. In this line, human tool use is based on motor programs about how the hand interacts with tools, implying that the use of end-effectors other than the hand should generate motor control difficulties (e.g., inability to reproduce a specific tool-use action over time), because these so-called programs characterize the spatiotemporal parameters of hand movements, but not of other end-effectors. To test this, we asked participants to perform three tool-use actions (e.g., pounding a nail) with four end-effectors (i.e., right foot, right elbow, left hand, right hand). We show that participants not only spontaneously performed the tool-use actions effectively, but also crucially kept tools' spatiotemporal parameters constant among the end-effectors. This phenomenon, which we call poly-dexterity, is at odds with the view that the human brain stores hand-centered motor programs for tool use. Poly-dexterity is instead consistent with the idea that, once the tool-use action is formed mentally, general motor programs can be applied to a variety of end-effectors. Reversing the usual evolutionary perspective, our findings support that, in the course of evolution, manual dexterity has come after tool-use skills.

Mobilization with movement and kinesio taping in knee arthritis-evaluation and outcomes.

INTRODUCTION: The aim of this study was to investigate the acute effects of Mulligan mobilization with movement (MwM) and taping on function and pain intensity in patients with osteoarthritis (OA). MATERIALS AND METHODS: Female patients aged between 40 and 70 years with knee OA participated in the study. The patients were divided into three groups and each group received different interventions. Group 1 received MwM and taping according to Mulligan's concept. Group 2 received MwM and placebo taping with no recovery effect and group 3 received placebo taping. Functional tests including lifting, picking up, sit and stand-up, socket tests in addition to climbing up and down stairs, ten metres walk, and timed up and go (TUG) tests were performed before and after intervention. Pain during the test performances were assessed by a visual analog scale. RESULTS: Performance in all tests improved significantly in the MwM + taping group, while only sit and stand-up, ten metres walk, and TUG test performances improved in the MwM + placebo taping group (p < 0.05). Pain intensity during the tests was also significantly better after intervention in those two groups (p < 0.05). Comparison between the groups showed that the pain intensity during all tests was less and functional test scores were better in sit and stand-up, ten metres walk, and walking down stairs in the MwM + taping group than the MwM + placebo taping group. CONCLUSIONS: MwM accompanied by taping improves pain during functional activities as well as the performance. MwM without taping may also improve pain intensity; however, it may be inadequate in increasing the performance.

3-Dimensional Cervical Movement Characteristics and the Influence of Thoracic Treatment on a Subgroup of Acute Neck Pain Patients.

OBJECTIVE: The purpose of this study was to investigate the influence of thoracic high-velocity low-amplitude thrust (HVLAT) manipulation on quantitative and qualitative 3-dimensional cervical spine kinematic patterns in a subgroup of patients with acute neck pain. METHODS: Thirty patients with acute neck pain, aged 20 to 59, received a thoracic HVLAT manipulation. Three-dimensional kinematics of the cervical spine were registered pretreatment and posttreatment using an electromagnetic tracking system. Quantitative and qualitative parameters were calculated for axial rotation, lateral bending, and flexion-extension movement. Subjective pain ratings were measured with the visual analogue scale and the Neck Disability Index and were collected pretreatment and posttreatment. RESULTS: After treatment, the range of motion of the main motion improved significantly for axial rotation (P = .034), lateral bending (P < .001), and flexion-extension (P = .031). Although for axial rotation as the main motion, the smoothness of the flexion-extension movement improved significantly after treatment (P = .036), the reverse was true for flexion-extension as the main motion. Visual analogue scale scores exhibited a statistically (P < .001) and clinically significant reduction of pain sensation. The mean change in Neck Disability Index scores only exhibited a statistically significant improvement 1 week after treatment. CONCLUSION: Thoracic HVLAT manipulation led to positive changes in quantitative and qualitative aspects of 3-dimensional cervical spine kinematics. Because of the 1-intervention group design, external factors influencing the healing process could not be eliminated.

Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion.

CONTEXT: Restricted dorsiflexion (DF) at the ankle joint can cause acute and chronic injuries at the ankle and knee. Myofascial release and instrument-assisted soft tissue mobilization (IASTM) techniques have been used to increase range of motion (ROM); however, evidence directly comparing their effectiveness is limited. OBJECTIVE: To compare the effects of a single session of compressive myofascial release (CMR) or IASTM using the Graston Technique (GT) on closed chain ankle-DF ROM. DESIGN: Randomized controlled trial. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Participants were 44 physically active people (53 limbs) with less than 30° of DF. INTERVENTION(S): Limbs were randomly assigned to 1 of 3 groups: control, CMR, or GT. Both treatment groups received one 5-minute treatment that included scanning the area and treating specific restrictions. The control group sat for 5 minutes before measurements were retaken. MAIN OUTCOME MEASURE(S): Standing and kneeling ankle DF were measured before and immediately after treatment. Change scores were calculated for both positions, and two 1-way analyses of variance were conducted. RESULTS: A difference between groups was found in the standing ( F2,52 = 13.78, P = .001) and kneeling ( F2,52 = 5.85, P = .01) positions. Post hoc testing showed DF improvements in the standing position after CMR compared with the GT and control groups (both P = .001). In the kneeling position, DF improved after CMR compared with the control group ( P = .005). CONCLUSIONS: Compressive myofascial release increased ankle DF after a single treatment in participants with DF ROM deficits. Clinicians should consider adding CMR as a treatment intervention for patients with DF deficits.

Common Manual Therapy Practices in the Netherlands for Infants With Upper Cervical Dysfunction: A Prospective Cohort Study.

OBJECTIVE: The purpose of this study was to describe common clinical practices of manual therapists (MTs) in the Netherlands for infants with indications of upper cervical dysfunction (UCD). METHODS: A prospective observational cohort study was conducted to gain insight into characteristics, reasons for seeking care, and common clinical practice for infants (<27 weeks) with indications of UCD, referred to MTs. Pre- and posttreatment self-reported questionnaires were used to collect data from parents and MTs. Parents reported on infant characteristics and perceived effect of treatment. Manual therapists reported on diagnostics, therapeutic procedures, and outcomes. RESULTS: Between 2006 and 2007, data regarding 307 referred infants (mean age: 11.2 weeks) were collected by parents and 42 MTs. The most frequent reasons for seeking care were positional preference, restlessness, and/or abnormal head position. Manual therapists observed active, spontaneous, and provoked mobility and passive upper cervical mobility. Of the 307 infants, 295 were diagnosed with UCD based on positive outcomes on the flexion-rotation test and/or lateral flexion test. After treatment with mobilization techniques, positive outcomes on the flexion-rotation test decreased from 78.8% to 6.8%. For the lateral flexion test, the positive outcomes decreased from 91.5% to 6.2%. All parents perceived positive treatment effects. No serious adverse events were reported during this study. CONCLUSIONS: This is the first study to describe common clinical practice for infants referred for manual therapy. Infants with UCD were treated mainly with upper cervical mobilization techniques, and the greatest perceived effect was observed after approximately 2 treatment sessions.

Bilateral anterior shoulder dislocation as a result of manipulation: A case report.

RATIONALE: Bilateral anterior shoulder dislocation is clinically rare and has been reported to be related to high-speed sports. PATIENT CONCERNS: A 76-year-old woman presented with bilateral shoulders pain after traditional Chinese manipulation. DIAGNOSES: She was diagnosed with bilateral anterior dislocations, and a closed reduction was immediately performed. INTERVENTION: The patient was referred for rehabilitation 3 days later, and bilateral rotator cuff injuries were identified from musculoskeletal ultrasound. After 4 weeks of physical therapy, the patient's shoulder pain had reduced and the passive ROM was nearly full. OUTCOMES: At 1-year follow-up, only mild intermittent shoulder pain was noted, and there was no limitation of shoulder ROM. LESSONS: This case illustrates that patients with acute shoulder injuries who receive proper diagnosis and treatment can achieve good outcomes. Therefore, patients with musculoskeletal disorders should seek qualified specialists for accurate diagnosis and appropriate management.

A finite element study of traditional Chinese cervical manipulation.

PURPOSE: Traditional Chinese cervical manipulation (TCCM) has been claimed as an effective treatment for diseases of the cervical spine, but its biomechanical effects on the vertebral body and intervertebral discs remain unclear. The aim of this study was to develop and validate a detailed finite element model of cervical spine, which was then used to investigate the biomechanical response of the cervical spine to TCCM. METHODS: The model of a C2-T1 cervical spine was constructed based on CT images of a healthy male volunteer and validated against published in vitro studies under different loading conditions. The detailed force-time data of TCCM were measured on the same volunteer through dynamometric diaphragms. The data were applied on the validated finite element model to simulate TCCM. RESULTS: The current model could offer potentials to effectively reflect the behavior of human cervical spine suitable for biomechanics studies of TCCM. Under simulated TCCM condition, the stress distributions in cervical spine and intervertebral discs could not be completely explained through the traditional theory. CONCLUSION: Spinal manipulation, or TCCM, might play no role in reducing intradiscal pressure for treating cervical spondylosis. It could cause less stress concentration in intervertebral discs while operating spinal manipulation or TCCM when the adjustment points was chosen near the root of spinous process than the top of spinous process.

Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment.

BACKGROUND: Manipulation and mobilisation are commonly used to treat neck pain. This is an update of a Cochrane review first published in 2003, and previously updated in 2010. OBJECTIVES: To assess the effects of manipulation or mobilisation alone compared wiith those of an inactive control or another active treatment on pain, function, disability, patient satisfaction, quality of life and global perceived effect in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache (CGH) at immediate- to long-term follow-up. When appropriate, to assess the influence of treatment characteristics (i.e. technique, dosage), methodological quality, symptom duration and subtypes of neck disorder on treatment outcomes. SEARCH METHODS: Review authors searched the following computerised databases to November 2014 to identify additional studies: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We also searched ClinicalTrials.gov, checked references, searched citations and contacted study authors to find relevant studies. We updated this search in June 2015, but these results have not yet been incorporated. SELECTION CRITERIA: Randomised controlled trials (RCTs) undertaken to assess whether manipulation or mobilisation improves clinical outcomes for adults with acute/subacute/chronic neck pain. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, abstracted data, assessed risk of bias and applied Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods (very low, low, moderate, high quality). We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs). MAIN RESULTS: We included 51 trials (2920 participants, 18 trials of manipulation/mobilisation versus control; 34 trials of manipulation/mobilisation versus another treatment, 1 trial had two comparisons). Cervical manipulation versus inactive control: For subacute and chronic neck pain, a single manipulation (three trials, no meta-analysis, 154 participants, ranged from very low to low quality) relieved pain at immediate- but not short-term follow-up. Cervical manipulation versus another active treatment: For acute and chronic neck pain, multiple sessions of cervical manipulation (two trials, 446 participants, ranged from moderate to high quality) produced similar changes in pain, function, quality of life (QoL), global perceived effect (GPE) and patient satisfaction when compared with multiple sessions of cervical mobilisation at immediate-, short- and intermediate-term follow-up. For acute and subacute neck pain, multiple sessions of cervical manipulation were more effective than certain medications in improving pain and function at immediate- (one trial, 182 participants, moderate quality) and long-term follow-up (one trial, 181 participants, moderate quality). These findings are consistent for function at intermediate-term follow-up (one trial, 182 participants, moderate quality). For chronic CGH, multiple sessions of cervical manipulation (two trials, 125 participants, low quality) may be more effective than massage in improving pain and function at short/intermediate-term follow-up. Multiple sessions of cervical manipulation (one trial, 65 participants, very low quality) may be favoured over transcutaneous electrical nerve stimulation (TENS) for pain reduction at short-term follow-up. For acute neck pain, multiple sessions of cervical manipulation (one trial, 20 participants, very low quality) may be more effective than thoracic manipulation in improving pain and function at short/intermediate-term follow-up. Thoracic manipulation versus inactive control: Three trials (150 participants) using a single session were assessed at immediate-, short- and intermediate-term follow-up. At short-term follow-up, manipulation improved pain in participants with acute and subacute neck pain (five trials, 346 participants, moderate quality, pooled SMD -1.26, 95% confidence interval (CI) -1.86 to -0.66) and improved function (four trials, 258 participants, moderate quality, pooled SMD -1.40, 95% CI -2.24 to -0.55) in participants with acute and chronic neck pain. A funnel plot of these data suggests publication bias. These findings were consistent at intermediate follow-up for pain/function/quality of life (one trial, 111 participants, low quality). Thoracic manipulation versus another active treatment: No studies provided sufficient data for statistical analyses. A single session of thoracic manipulation (one trial, 100 participants, moderate quality) was comparable with thoracic mobilisation for pain relief at immediate-term follow-up for chronic neck pain. Mobilisation versus inactive control: Mobilisation as a stand-alone intervention (two trials, 57 participants, ranged from very low to low quality) may not reduce pain more than an inactive control. Mobilisation versus another active treatment: For acute and subacute neck pain, anterior-posterior mobilisation (one trial, 95 participants, very low quality) may favour pain reduction over rotatory or transverse mobilisations at immediate-term follow-up. For chronic CGH with temporomandibular joint (TMJ) dysfunction, multiple sessions of TMJ manual therapy (one trial, 38 participants, very low quality) may be more effective than cervical mobilisation in improving pain/function at immediate- and intermediate-term follow-up. For subacute and chronic neck pain, cervical mobilisation alone (four trials, 165 participants, ranged from low to very low quality) may not be different from ultrasound, TENS, acupuncture and massage in improving pain, function, QoL and participant satisfaction at immediate- and intermediate-term follow-up. Additionally, combining laser with manipulation may be superior to using manipulation or laser alone (one trial, 56 participants, very low quality). AUTHORS' CONCLUSIONS: Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.

Immediate Effects of Combining Local Techniques in the Craniomandibular Area and Hamstring Muscle Stretching in Subjects with Temporomandibular Disorders: A Randomized Controlled Study.

OBJECTIVE: To assess the immediate effects on vertical mouth opening, orofacial mechanosensitivity, and lumbar and suboccipital mobility after adding a myofascial induction technique to a multimodal protocol in subjects with temporomandibular disorders (TMD). DESIGN: A randomized and double-blind controlled trial was carried out. SETTINGS/LOCATION: University-based physical therapy research clinic. SUBJECTS: Sixty subjects (35±11.22 years) with TMD, and restricted mobility of the mandibular condyles and the first cervical vertebrae, were recruited and randomized to either a control group (CG) (n=30) or an experimental group (EG) (n=30). INTERVENTIONS: The CG underwent a neuromuscular technique over the masseter muscles and passive hamstring muscle stretching. A suboccipital muscle inhibition technique was added to this protocol in the EG. OUTCOME MEASURES: Primary measurements were made of vertical mouth opening and pressure pain threshold of the masseter muscles. Secondary outcome measures included pressure algometry of the trigeminal nerve, suboccipital range of motion, and lumbar spine mobility, assessed with the sit-and-reach (SAR) test and lumbar forward bending. All evaluations were collected at baseline and immediately after intervention. RESULTS: In the intragroup comparison, the EG observed an increase in suboccipital flexion (p<0.001; F1,29=14.47; R(2)=0.33) and the SAR test (p=0.009; F1,29=7.89; R(2)=0.21). No significant differences were found in the between-group comparison for any variable (p>0.05). CONCLUSION: The inclusion of a myofascial induction maneuver in a protocol combining local (neuromuscular treatment) and distal techniques (hamstring stretching) in subjects with TMD has no impact on improving mouth opening, suboccipital and lumbar mobility, and orofacial sensitivity to mechanical pressure.