Short-term effects of spinal thrust joint manipulation on postural sway in patients with chronic mechanical neck pain: a randomized controlled trial.

PURPOSE: Our aim was to compare the efficacy of spinal manipulation of the upper cervical spine (C1-C2) on postural sway in patients with chronic mechanical neck pain with the application of a combination of cervical (C3-C4), cervicothoracic (C7-T1) and thoracic spine (T5-T6) thrust joint manipulation. METHODS: One hundred eighty-six (n = 186) individuals with chronic mechanical neck pain were randomised to receive an upper cervical spine manipulation (n = 93) or three different spinal manipulation techniques applied to the cervical spine, cervicothoracic joint and thoracic spine (n = 93). Measures included the assessment of stabilometric parameters using the Medicapteurs S-Plate platform. Secondarily, neck pain was analysed using the Numeric Pain Rating Scale. RESULTS: We observe a decrease in the length of the centre of pressure path, average speed, medio-lateral and antero-posterior displacement with statistically significant results (p < 0.05) in the upper cervical manipulation group. Both interventions are equally effective in reducing neck pain after fifteen days (p < 0.001). CONCLUSION: The application of upper cervical thrust joint manipulation is more effective in improving stabilometric parameters in patients with chronic mechanical neck pain. Trial registration: The study was registered in the Australian and New Zealand Clinical Trial Registry (no. ACTRN12619000546156).Implications for rehabilitationPatients who suffer from neck pain exhibit increased postural sway than asymptomatic subjects.Both spinal manipulation treatments applied in this study are equally effective in reducing neck pain.Spinal manipulation treatment on the upper cervical spine improves postural stability parameters.

Development of a clinical prediction rule for identifying women with tension-type headache who are likely to achieve short-term success with joint mobilization and muscle trigger point therapy.

OBJECTIVE: To identify prognostic factors from the history and physical examination in women with tension-type headache (TTH) who are likely to experience self-perceived clinical improvement following a multimodal physical therapy session including joint mobilization and muscle trigger point (TrP) therapies. BACKGROUND: No definitive therapeutic intervention is available for TTH. It would be useful for clinicians to have a clinical prediction rule for selecting which TTH patients may experience improved outcomes following a multimodal physical therapy program. METHODS: Women diagnosed with pure TTH by 3 experienced neurologists according to the International Headache Society criteria from different neurology departments were included. They underwent a standardized examination (neck mobility, pressure pain thresholds, total tenderness score, presence of muscle TrPs, Medical Outcomes Study 36-Item Short Form, the Neck Disability Index [NDI], the Beck Depression Inventory, and the Headache Disability Inventory) and then a multimodal physical therapy session including joint mobilization and TrP therapies. The treatment session included a 30-second grade III or IV central posterior-anterior nonthrust mobilization applied from T4 to T1 thoracic vertebrae, at C7-T1 cervico-thoracic junction and C1-C2 vertebrae for an overall intervention time of 5 minutes Different TrP techniques, particularly soft tissue stroke, pressure release, or muscle energy were applied to head and neck-shoulder muscles (temporalis, suboccipital, upper trapezius, splenius capitis, semispinalis capitis, sternocleidomastoid) to inactivate active muscle TrPs. Participants were classified as having achieved a successful outcome 1 week after the session based on their self-perceived recovery. Potential prognostic variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of success. RESULTS: Data for 76 subjects were included in the analysis, of which 36 experienced a successful outcome (48%). Eight prognostic variables were retained in the regression model: mean age <44.5 years, presence of left sternocleidomastoid TrP, presence of suboccipital TrP, presence of left superior oblique muscle TrP, cervical rotation to the left > 69°, total tenderness score <20.5, NDI <18.5, referred pain area of right upper trapezius muscle TrP >42.23. CONCLUSIONS: The current clinical prediction rule may allow clinicians to make an a priori identification of women with TTH who are likely to experience short-term self-report improvement with a multimodal session including joint mobilizations and TrP therapies. Future studies are necessary to validate these findings.

Immediate effects of hamstring muscle stretching on pressure pain sensitivity and active mouth opening in healthy subjects.

OBJECTIVE: This study analyzed the immediate effect of hamstring muscle stretching on pressure pain sensitivity over the masseter and the upper trapezius muscles and maximum active mouth opening in healthy subjects. METHODS: One hundred twenty volunteers, 70 males and 50 females, between the ages of 22 and 47, were randomly divided into 3 groups: group 1 (control group) that did not receive any intervention, group 2 where a unilateral hamstring muscle stretching was applied, and group 3 where a bilateral stretching was applied. Pressure pain thresholds (PPTs) were bilaterally assessed over the masseter and upper trapezius muscles pre- and 5 minutes posttreatment by an assessor blinded to group assignment. Maximum mouth opening was also assessed pre- and 5 minutes posttreatment. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the intervention. The primary analysis was the group x time interaction. RESULTS: The ANOVA revealed significant group x time interaction for changes in PPTs over the upper trapezius (F = 4.5; P = .01) and masseter (F = 6.3; P = .002) muscles. Pre-post effect sizes were moderate (0.5 >d > 0.7) for both stretching groups and negative (d < -0.2) for the control group. A significant group x time interaction (F = 8.15; P < .001) for maximum mouth opening was also found; both experimental groups showed greater improvement when compared to the control group (P < .001). Pre-post effect sizes were large (d > 0.7) for both stretching groups and negative (d < -0.2) for the control group. CONCLUSIONS: The application of a stretching of the hamstring musculature produced an immediate increase in PPTs over both masseter and upper trapezius muscles in healthy subjects.

Immediate effects of manipulation of the talocrural joint on stabilometry and baropodometry in patients with ankle sprain.

OBJECTIVE: This study assessed the immediate effects of talocrural joint manipulation on stabilometric and baropodometric outcomes in patients with grade II ankle sprain. METHODS: Fifty-two field hockey players (35 men and 17 women) between 18 and 40 years old (mean = 22.5 years, SD = 3.6 years) were included in this study. A simple blind, intrapatient, placebo-controlled, and repeated-measures study was carried out. All the patients underwent a baropodometric study performed with a Foot Work force platform (4 times; pre-post placebo group and pre-post intervention group). The sample was subjected to two techniques of manipulative treatment: (a) talocrural joint manipulation and (b) posterior gliding manipulation over the talus. In a second instance, placebo manipulation was applied. Unilateral analysis of variance and multivariate analysis of variance were used for statistical analysis. RESULTS: The results in the intervention group revealed significant differences in the percentage of posterior load on the foot (P = .015) and the percentage of bilateral anterior load (P = .02) before and after the manipulation. The placebo group did not show any change in any of the variables except for area (P = .045). Intergroup comparison revealed statistically significant differences in the increase in percentage of posterior load on the manipulated foot, percentage of bilateral posterior load, percentage of anterior load on the manipulated foot, and percentage of bilateral anterior load (with the exception of the total load on the foot). CONCLUSIONS: The application of caudal talocrural joint manipulation, as compared with placebo manipulation, in athletic patients with grade II ankle sprain redistributed the load supports at the level of the foot.

Changes in neck pain and active range of motion after a single thoracic spine manipulation in subjects presenting with mechanical neck pain: a case series.

OBJECTIVE: Our aim was to report changes in neck pain at rest, active cervical range of motion, and neck pain at end-range of cervical motion after a single thoracic spine manipulation in a case series of patients with mechanical neck pain. METHODS: Seven patients with mechanical neck pain (2 men, 5 women), 20 to 33 years old, were included. All patients received a single thoracic manipulation by an experienced manipulative therapist. The outcome measures of these cases series were neck pain at rest, as measured by a numerical pain rating scale; active cervical range of motion; and neck pain at the end of each neck motion (eg, flexion or extension). These outcomes were assessed pre treatment, 5 minutes post manipulation, and 48 hours after the intervention. A repeated-measures analysis was made with parametric tests. Within-group effect sizes were calculated using Cohen d coefficients. RESULTS: A significant (P < .001) decrease, with large within-group effect sizes (d > 1), in neck pain at rest were found after the thoracic spinal manipulation. A trend toward an increase in all cervical motions (flexion, extension, right or left lateral flexion, and right or left rotation) and a trend toward a decrease in neck pain at the end of each cervical motion were also found, although differences did not reach the significance (P > .05). Nevertheless, medium to large within-group effect sizes (0.5 < d < 1) were found between preintervention data and both postintervention assessments in both active range of motion and neck pain at the end of each neck motion. CONCLUSIONS: The present results demonstrated a clinically significant reduction in pain at rest in subjects with mechanical neck pain immediately and 48 hours following a thoracic manipulation. Although increases in all tested ranges of motion were obtained, none of them reached statistical significance at either posttreatment point. The same was found for pain at the end of range of motion for all tested ranges, with the exception of pain at the end of forward flexion at 48 hours. More than one mechanism likely explains the effects of thoracic spinal manipulation. Future controlled studies comparing spinal manipulation vs spinal mobilization of the thoracic spine are required.

A Systematic Review of the Soft-Tissue Connections Between Neck Muscles and Dura Mater: The Myodural Bridge.

STUDY DESIGN: Systematic review. OBJECTIVE: To elucidate the existence of soft tissue connections between the neck muscles and cervical dura mater. SUMMARY OF BACKGROUND DATA: Several studies discuss the existence of a cervical myodural bridge; however, conflicting data have been reported. METHODS: Searches were conducted in the PubMed, Web of Science, Cochrane Library, and PEDro databases. Studies reporting original data regarding the continuity of non-post-surgical soft tissue between the cervical muscles and dura mater were reviewed. Two reviewers independently selected articles, and a third one resolved disagreements. Another two researchers extracted the methodology of the study, the anatomical findings, and evaluated the quality of the studies using Quality Appraisal for Cadaveric Studies Scale. A different third researcher resolved disagreements. RESULTS: Twenty-six studies were included. A soft tissue connection between the rectus capitis posterior minor, the rectus capitis posterior major, and the obliquus capitis inferior muscles seems to be proved with a strong level of evidence for each one of them. Controversy exists about the possible communication between the dura mater and the upper trapezius, rhomboideus minor, serratus posterior superior, and splenius capitis by means of the ligamentum nuchae. Finally, there is limited evidence about the existence of a soft tissue connection between rectus capitis anterior muscle and the dura mater. CONCLUSION: There is a continuity of soft tissue between the cervical musculature and the cervical dura mater; this might have physiological, pathophysiological, and therapeutic implications, and going some way to explaining the effect of some therapies in craniocervical disorders. LEVEL OF EVIDENCE: N/A.

La maniobra hemodinámica abdominal Modificada / No disponible

La Maniobra Hemodinámica del Abdomen es una de las técnicas más utilizadas en Osteopatía para el tratamiento de determinadas disfunciones viscerales. La técnica pretende generar un estímulo neuro-vascular a nivel abdominopélvico, eliminar la congestión abdominopélvica, liberar algunas de las adherencias existentes entre las vísceras y las estructuras vecinas recuperando así la movilidad del órgano, mejorar y estimular los movimientos peristálticos del sistema digestivo, mejora de la función del sistema nervioso vegetativo, normalización del metabolismo dependiente de la víscera y disminuir o eliminar los dolores referidos al aparato locomotor de origen visceral. Las contraindicaciones al tratamiento con dicha técnica son básicamente procesos neoplásicos, infecciosos y hemorrágicos. Es imprescindible realizar un adecuado diagnóstico diferencial y determinar la disfunción osteopática visceral

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El estreñimiento y su tratamiento con técnicas manuales / No disponible

Introducción: El estreñimiento es una de los motivos de consulta más habituales en Medicina del Aparato Digestivo con entre un 25-50 % de las visitas. Tiene un gran impacto en el empeoramiento de la calidad de vida del paciente ya sean recién nacidos, adultos o pacientes con enfermedades neurológicas. Los pacientes con estreñimiento suelen tener el sistema inmune alterado con el consiguiente riesgo de padecer enfermedades autoinmunes. Se asocia el estreñimiento con un aumento del riesgo de cáncer colorrectal. Objetivo: Presentar una visión actual de una de las patologías más comunes en Medicina Digestiva; el estreñimiento, y un posible tratamiento como es la Osteopatía Visceral Material y métodos: Revisión bibliográfica del estreñimiento y los ensayos controlados aleatorizado (ECA) realizados con técnicas viscerales. La búsqueda se realizó a través de CINHAL, OTseeker, Lilacs, Scielo, Ebsco Host, Proquest, Science Direct y Dialnet. Resultados: La búsqueda finaliza con nueve estudios, en los cuales, se incluía el tratamiento visceral para valorar la mejoría de la sintomatología del estreñimiento funcional. Conclusiones: El tratamiento manual de intestino delgado y grueso mejora la sintomatología gastrointestinal, el dolor abdominal y aumenta el número de deposiciones semanales

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Movilidad lumbopélvica en pacientes estreñidos tras la maniobra hemodinámica abdominal modificada / No disponible

Introducción: El estreñimiento funcional es la patología más frecuente en Gastroenterología. Recientes estudios aseveran una presencia del 78% de dolores referidos al aparato locomotor de origen visceral. Objetivos: Evaluar la Maniobra Hemodinámica abdominal modificada (MHAM) en pacientes estreñidos a través del Umbral de dolor a la presión (UDP) en los niveles dorsales T10,T11 y T12, inclinometría para la flexión lumbar, el test de extensibilidad Sit and Reach y la valoración postural del paciente con el programa SAPO. Material y Métodos: Ensayo clínico aleatorizado controlado, a doble ciego en 20 pacientes (n=20); Grupo Control (GC: n=10) y Grupo Experimental (GE: n=10). Resultados: Algometría T11: en el GE la diferencia media fue de 1,05 kg (IC95%=0,501 a 1,603; p=0,001; d Cohen= 0,84). Algometría T12: en el GE la diferencia fue 1,23 kg (IC95%=0,499 a 1,969; p=0,002 significativa; d Cohen=0,89). Inclinometría T12: en el GE se produjo un incremento medio de 10,4º (IC 95%=7,59 a 13,21º; p<0,001; d Cohen=0,94).Test Sit and Reach: en el GE el aumento medio fue de 3,47cm (IC95%= 2,35 a 4,58 cm; p<0,001; d Cohen=0,77). Conclusiones: La aplicación de la Maniobra Hemodinámica Abdominal Modificada en pacientes con estreñimiento funcional genera cambios inmediatos aumentando la tolerancia al dolor en las vértebras T11 y T12, aumentando la flexión lumbar y mejorando la extensibilidad de los miembros inferiores (AU)

No dispoible

Técnicas manipulativas vertebrales como terapia osteopática en el dolor cervical / Vertebral manipulative techniques such as osteopathic therapy for neck pain

Introducción: Se considera a la cervicalgia como una de las patologías con mayor incidencia en la población. Las manipulaciones espinales utilizadas en Osteopatía, terapia manual y Quiropraxia parecen ofrecer buenos resultados restituyendo la fisiología cervical, por lo que consideramos necesario revisar la evidencia actualizada en esta área y resumir que técnicas arrojan mejores resultados a corto y largo plazo. Objetivo: Comparar el efecto de la manipulación de alta velocidad y corta amplitud (HVLA) dirigida tanto a la columna cervical como a la dorsal y de las técnicas de movilización solas y/o comparadas con otras técnicas en la recuperación de movilidad la disminución del dolor y la disminución de la discapacidad. Material y Métodos: Se realiza una búsqueda bibliográfica en PubMed (Medline), Scopus y PEDro. Encontramos 1.020 artículos relacionados, aunque se incluyeron 11 revisiones sistemáticas/metaanálisis y 18 ensayos controlados aleatorizados, de cohortes o serie de casos, por lo que han sido analizadas veintinueve publicaciones (n=29) en texto completo. Resultados: En el dolor agudo del cuello, en la primera hora después de la intervención, las técnicas de HVLA obtienen resultados superiores a los medicamentos recetados en urgencias y en el dolor crónico a corto, medio y largo plazo, son claramente superiores a la visita médica y medicamentos. También obtienen mejores resultados que las intervenciones electro/termales, que el Kinesiotaping(R), el ejercicio, el láser en disfunciones facetarías y otras terapia. Los efectos adversos, en su mayoría, son síntomas de leve duración en las primeras 24 horas, y raramente son intensos. Conclusiones: Las técnicas manipulativas producen efectos analgésicos, de aumento del rango articular, de la función, de la satisfacción del paciente y de la calidad de vida en el dolor del cuello, tanto agudo como crónico, con o sin dolores asociados, a corto, medio y largo plazo (AU)

Introduction: Neck pain is considered one of the most frequent pathologies in the population. Spinal manipulations used in osteopathy, manual therapy and chiropractics seem to offer good results in restoring cervical physiology. Therefore, we consider it necessary to review the updated evidence in this area and summarize which techniques show better results in the short and long term. Objective: To compare the effect of high speed manipulation and low amplitude (HVLA), targeting both the cervical and the dorsal spine and mobilization techniques alone and/or compared with other techniques in mobility recovery, pain reduction and disability reduction. Material and methods: A bibliographical search was conducted in PubMed (Medline), Scopus and PEDro. We found 1020 related articles, although 11 systematic reviews/metaanalysis were included and 18 randomized controlled trials, cohort trials or case series, twenty publications having been analyzed (n = 29) in full text. Results: In acute neck pain, in the first hour after intervention, HVLA techniques get superior results as compared to prescription drugs in emergencies and chronic pain in the short, medium and long term and are clearly superior to medical visits and medicines. They also perform better than electro thermal interventions, Kinesiotaping®, exercise, laser in faceting dysfunctions and other therapy. Adverse effects are mostly short duration symptoms in the first 24 hours, and are rarely severe. Conclusions: The manipulative techniques produce analgesic effects, an increase in joint range, range of function, patient satisfaction and the quality of life in neck pain, both acute and chronic, with or without associated pain, in the short, medium and long term (AU)

Repeated Applications of Thoracic Spine Thrust Manipulation do not Lead to Tolerance in Patients Presenting with Acute Mechanical Neck Pain: A Secondary Analysis.

It has been demonstrated that patients receiving mobilization techniques do not exhibit tolerance to repeated applications. However, this phenomenon has not been investigated for thoracic manipulation. Our aim was to determine if patients receiving thoracic thrust manipulation exhibit tolerance to repeated applications in acute mechanical neck pain. Forty-five patients were randomly assigned to two groups. The control group received electro- and thermotherapy for 5 sessions, and the experimental group received the same program and also received a thoracic thrust manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain and cervical mobility. Within-session change scores for pain and mobility during treatment sessions #1, 3, and 5 were examined with a one-way repeated measured ANOVA. A 2-way ANOVA with session as within-subject variable and group as between-subject variable was used to compare change scores for each visit between groups to ascertain if there were significant between-group differences in within-session changes for the experimental versus the control group. The ANOVA showed that for either group the 3 within-session change scores were not significantly different (P > 0.1). The 2-way ANOVA revealed significant differences between groups for both pain and neck mobility in within-session change scores (all, P < 0.001). Change scores in each session were superior in the experimental group as compared to those in the control group. The results suggest that patients receiving thoracic manipulation do not exhibit tolerance to repeated applications with regard to pain and mobility measures in acute mechanical neck pain. Further studies should investigate the dose-response relationship of thoracic thrust manipulation in this population.

Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: a randomized clinical trial.

Our aim was to examine the effects of a seated thoracic spine distraction thrust manipulation included in an electrotherapy/thermal program on pain, disability, and cervical range of motion in patients with acute neck pain. This randomized controlled trial included 45 patients (20 males, 25 females) between 23 and 44 years of age presenting with acute neck pain. Patients were randomly divided into 2 groups: an experimental group which received a thoracic manipulation, and a control group which did not receive the manipulative procedure. Both groups received an electrotherapy program consisting of 6 sessions of TENS (frequency 100Hz; 20min), superficial thermo-therapy (15min) and soft tissue massage. The experimental group also received a thoracic manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain (numerical pain rate scale; NPRS), level of disability (Northwick Park Neck Pain Questionnaire; NPQ) and neck mobility. These outcomes were assessed at baseline and 1 week after discharge. A 2-way repeated-measures ANOVA with group as between-subject variable and time as within-subject variable was used. Patients receiving thoracic manipulation experienced greater reductions in both neck pain, with between-group difference of 2.3 (95% CI 2-2.7) points on a 11-NPRS, and perceived disability with between-group differences 8.5 (95% CI 7.2-9.8) points. Further, patients receiving thoracic manipulation experienced greater increases in all cervical motions with between-group differences of 10.6 degrees (95% CI 8.8-12.5 degrees) for flexion; 9.9 degrees (95% CI 8.1-11.7 degrees) for extension; 9.5 degrees (95% CI 7.6-11.4 degrees) for right lateral-flexion; 8 degrees (95% CI 6.2-9.8 degrees) for left lateral-flexion; 9.6 degrees (95% CI 7.7-11.6 degrees) for right rotation; and 8.4 degrees (95% CI 6.5-10.3 degrees) for left rotation. We found that the inclusion of a thoracic manipulation into an electrotherapy/thermal program was effective in reducing neck pain and disability, and in increasing active cervical mobility in patients with acute neck pain.