Phasic exercises for cervical rehabilitation after "whiplash" trauma.

OBJECTIVE: To assess whether "phasic" exercises, including rapid eye-head-neck-arm movements, can benefit patients with chronic cervical injuries. DESIGN: A randomized, controlled, double blind study involving 30 chronic patients, who were allocated to either group 1 or group 2. The study period was for 8 wk. SETTING: The study was conducted in a private practice. PATIENTS: Thirty chronic motor vehicle accident patients who continued to experience increased pain/soreness/stiffness of the cervical musculature with sports/activities requiring rapid head neck movements were selected for the study. INTERVENTION: Group 1 patients (n = 15) had standard exercises (stretching/isometric/isokinetic) and chiropractic therapy. Group 2 patients (n = 15) had "phasic" exercises and chiropractic therapy. Patients in both groups exercised for a minimum of four times weekly, for 8 wk. MAIN OUTCOME MEASURE: Pre and Post Pain and Disability Index was administered to both groups. RESULTS: Group 1, which had standard exercises and chiropractic therapy, improved by 7.4% (p > .05). Group 2, which had "phasic" exercises and chiropractic therapy, improved by 48.3% (p > .001). Confounders were identified, which explains the minimal improvement of group 1 and the remarkable results of group 2. CONCLUSIONS: It would appear that any rehabilitation program for chronic neck-injured patients should involve exercises that address the following: eye-head-neck-arm coordinated movements, coordination of the entire vertebral column,/ and return the "phasic" component of the musculature to functional levels. Additional studies will address the effect of these exercises on the strength, range of motion and pain improvement of the cervical spine in normal, acute and chronic patients.

Assessment of cervicogenic vertigo.

A new method for assessing cervicogenic vertigo is presented. This method can quickly assess the origins of vertigo. Preliminary data on 235 patients found that 112, (47.6%), were positive to the tests. After 18 treatments, 101 of the patients (90.2%) were symptom free. The patients responding best suffered acute upper cervical joint problems, along with muscle trauma in that region. The neurophysiology of the area is reviewed so that the mechanisms and the tests are understood.

The chiropractic management and rehabilitation of cervical trauma.

A new protocol for the management and rehabilitation of the traumatized cervical spine is presented. Research data indicates that the present chiropractic approach for treating the cervical spine may be inadequate and must change. The change must be toward more specific treatments and active long-term care, with the goal of restoring the traumatized area to normal function. The new protocol consists of four well-defined stages, with each stage defined by its operational end-point. The stages are: pain reduction, mobilization, manipulation, and rehabilitation. Each stage is outlined in detail with an explanation regarding what has to be done and why.

The direct connections of the C2 dorsal root ganglia in the Macaca irus monkey: relevance to the chiropractic profession.

In order to assess the direct connections of the C2 Dorsal Root Ganglion, the right ganglion in each of three Macaca Irus Monkeys was injected with labelled 3H-leucine. After survival times of 24 hours and autoradiographic techniques, the slides were read using light and dark field microscopes and mapped onto enlarged cross sectional drawings. Results show labelling into the lateral cervical nucleus, the central cervical nucleus and caudal to C5 of the spinal cord. Cephalad projections were into the medullary nuclei: cuneatus, lateral cuneatus, nucleus tractus solitarius, intercalatus, and X of the vestibular system. The relevance to chiropractic therapeutics is outlined, and this data will be used in a later paper to outline the office routine for assessing vertigo/dizziness of cervical origin.

Neural mechanisms involved in the control of the eye-head-neck co-ordinated movement: a review of literature with an emphasis on future directions for the chiropractic profession.

Pathways for visual (sensory) information into the CNS are explained. The hypothesized areas where this sensory information begins to initiate the motor program include the periarcuate area, superior colliculus, and the areas of the motor program such as the Cortex, superior colliculus and reticular formation, along with the control exerted on the systems via the cerebellum and vestibular nuclei. The information demonstrates that the co-ordinated movements of eye-head-neck towards a goal, involves a number of parallel independently active neural centres which initiate the movements. However, there is continuous monitoring of these separate pathways by areas of the CNS in order to achieve that salient feature of the CNS, co-ordinated motion. A method of assessing the system, which will provide valuable information for the clinician and will be a rewarding area of research for the chiropractic profession is herein described.

Therapeutic traction: a review of neurological principles and clinical applications.

A brief review of traction and its application as a therapeutic tool is outlined. The preliminary results obtained indicate that traction, as used in this study, along with isokinetic exercises and chiropractic manipulation, have a very positive effect on tension headaches originating from the posterior muscles in conjunction with pathomechanics of the cervical spine. A brief but pertinent review of the literature dealing with the anatomy and physiology of the muscle spindle, the muscles, the joints, the neural connections in the spinal cord and the central nervous system is presented, to provide the basic principles of the possible mechanisms underlying the therapeutic result obtained. This framework also provides the basis of a second paper, which will explore the neural control mechanisms that are intrinsic in the control of the head, eyes and cervical spine movement, with the view of utilizing these to facilitate manipulation of this region.