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PubMedDate not supplied

An investigation into the production of intra-articular gas bubbles and increase in joint space in the zygapophyseal joints of the cervical spine in asymptomatic subjects after spinal manipulation.

OBJECTIVES: To analyze the size and density of cervical zygapophyseal joint spaces in asymptomatic subjects using computed tomography (CT) and plain film radiography. The joint spaces were analyzed before manipulation without traction, before manipulation with manual traction, after manipulation without traction, and after manipulation with manual traction. The data obtained before the manipulation were compared with data obtained after the manipulation to determine if significant alterations occurred. DESIGN: Twenty-two asymptomatic subjects were placed into 1 or more of 6 possible experimental groups. In all experimental groups, except for experiment 1, the subjects underwent: (step 1) a premanipulation radiograph and/or CT scan, (step 2) a premanipulation plus traction radiograph and/or CT scan, (step 3) a postmanipulation radiograph and/or CT scan, and (step 4) a postmanipulation plus traction radiograph and/or CT scan. RESULTS: Except for experiment 2, there was no significant change in the width, area, and density values of the zygapophyseal joint spaces immediately after the manipulation in either the traction or traction-free positions of the neck, and no visible radiolucent cavities were demonstrated in any view. CONCLUSION: No evidence of gas in the joint space or obvious increase in zygapophyseal joint space width immediately after the manipulation was found. This was evident in both the traction and traction-free postmanipulation scans and plain film images. This is not consistent with the current understanding of cavitation in joints, in particular, the refractory period.

Adult↗
PubMed2000

Effects of spinal manipulative therapy on autonomic activity and the cardiovascular system: a case study using the electrocardiogram and arterial tonometry.

OBJECTIVE: To determine if there is alteration in the autonomic nervous and cardiovascular systems after chiropractic manipulative therapy (CMT). A novel approach was used to quantitatively probe for changes in the activity of the autonomic nervous system, in blood pressure, and in pressure pulse transmission time. This approach uses the electrocardiogram and arterial tonometry equipment. DESIGN: This case study involves 1 subject treated over a 6-week period (2 visits/week). Respiration, electrocardiogram, and left and right radial artery blood pressures were measured during the baseline (2 visits) and treatment (10 visits) phases. Measurements were obtained before (n = 3) and after (n = 3) a break period (baseline) or before and after CMT. High-velocity, low-amplitude CMT that produced joint cavitation was used. SETTING: The study was performed at the Parker College Research Institute in a temperature-controlled laboratory. MAIN OUTCOME MEASURES: Fourier analysis was performed on the electrocardiogram-determined rest-redistribution intervals. The low frequency power between 0.04 to 0.15 Hz and the high frequency power between 0.15 to 0.40 Hz represent the activity of the sympathetic and parasympathetic nervous systems, respectively. The main outcome measure was the sympathovagal index, which is determined from the ratio of low frequency to high frequency. The arterial pressure and the time for pressure pulses to travel from the heart to the radial artery recording sites (pressure pulse transmission time) were studied. Differences (average of 3 measurements after treatment minus measurements before treatment) for each variable were calculated. RESULTS: After the 1st CMT treatment, the difference between treatment and baseline decreased for both the low frequency/high frequency (-2.804 +/- 1.273) and low frequency power (-0.135 +/- 0.056). These findings indicated that the parasympathetic nervous system predominated the sympathetic nervous system. After the 3rd, 4th, 6th, and 9th treatment, the difference between treatment and baseline increased for low frequency/high frequency (0.908 +/- 0.338, 2.313 +/- 0.300, 2.776 +/- 1.102, and 0. 988 +/- 0.269, respectively) and indicated that the sympathetic nervous system predominated the parasympathetic nervous system. In addition, the difference between treatment and baseline for the pressure pulse transmission time decreased bilaterally after the 4th treatment (left, -13.52 +/- 3.70 ms; right, -9.75 +/- 3.76 ms) and 6th treatment (left, -9.53 +/- 3.60 ms; right, -9.24 +/- 3.50 ms), which indicated that arterial compliance had decreased. Furthermore, after the 6th treatment, the difference between treatment and baseline for the rest-redistribution interval time decreased (-0.084 +/- 0.014 s). The difference between treatment and baseline for the systolic, diastolic, and mean arterial pressure for the above-mentioned treatments was not considered significant. CONCLUSION: This case study is the first to attempt to use electrocardiogram and arterial tonometry data to study the effects of CMT on the autonomic nervous and cardiovascular systems over an extended period of time. These devices allowed a more in-depth study of the cardiovascular and autonomic changes associated with CMT. Although changes in the autonomic nervous and cardiovascular systems can be detected, further development of a reliable and reproducible experimental protocol is required before validating the effects of CMT on these systems.

Adult↗
PubMed2001

Recruitment and accrual of women in a randomized controlled trial of spinal manipulation.

OBJECTIVE: To report on recruitment efforts and accrual rates for a nonmusculoskeletal chiropractic clinical trial. DESIGN: Information regarding the method of recruitment was collected for each individual who responded to an advertisement and completed an interviewer-administered telephone screening. SETTING: A suburban chiropractic teaching clinic with recruitment efforts extending throughout the larger metropolitan area. PATIENTS: A total of 2312 women were screened for participation and the advertisement source was noted for each. Of these, 138 women were recruited and fulfilled all study requirements. MAIN OUTCOME MEASURES: The numbers of responses and accrual rates were determined for 8 different recruitment methods: newspaper advertisements, community referrals, radio advertisements, community colleges, press releases, a community electronic sign, public television, and local posters. RESULTS: The most effective recruitment methods were newspaper advertisements, community referrals, and radio advertisements; the least effective methods were public television and local posters. CONCLUSIONS: The effort required for the recruitment of subjects was underestimated in this study. Based on the information gained, future recruitment methods for study participants will primarily focus on low-effort, high-yield methods such as newspaper and radio advertising, followed by press releases, campus electronic signs, and public television.

Adult↗
PubMed2001

Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent low back pain.

OBJECTIVE: To investigate the recovery pattern in chiropractic patients being treated for long-lasting or recurrent low back pain; in particular, to identify the minimum number of required treatments and the minimum number of days from the beginning of treatment to the occurrence of improvement. DESIGN: Prospective, uncontrolled multicenter study. SETTING: Private practice. PARTICIPANTS: Each of 19 selected Norwegian chiropractors provided 10 consecutive patients; each of the latter fulfilled a set of criteria (low back pain, a present episode longer than 2 weeks in duration, a total of more than 4 weeks of low back pain in the preceding year, no chiropractic treatment during the preceding 6 months, and suitability for manipulation). Response Rate: Data were collected on 164 patients (86% of the optimal study sample), 6 of whom were excluded. This left 158 patients for the analyses. MAIN OUTCOME MEASURES: Information on low back pain status was collected on each visit (maximum, 12 visits) through use of both a 10-point numeric pain rating scale and a global improvement scale (for the question "Do you feel that you have improved since you began receiving chiropractic treatment?," 5 answers were possible, ranging from "Yes, definite improvement" to "No, I am worse now than when the treatment started"). With respect to the numeric pain rating scale, "improvement" was defined as the point at which the score reached 2 for the first time or, if the initial score was 2, the point at which the score reached 1 for the first time. With respect to the global improvement scale, "improvement" was defined as the point at which the patient first answered "Yes, definite improvement." RESULTS: Approximately 50% of patients reported that they had "improved" at the 4th visit and within 2 weeks. After this time, fewer new cases of "improvement" occurred for every visit or day since the first treatment. At the 12th visit (earlier if treatment was concluded before the 12th visit), approximately 75% of the patients reported that "improvement" had occurred. CONCLUSION: There is a large group of chiropractic patients with relatively long-lasting or recurrent low back pain who report "improvement" early in the course of treatment.

Humans↗
PubMed2003

Is cervical spinal manipulation dangerous?

OBJECTIVE: Concern about cerebrovascular accidents after cervical manipulation is common. We report a case of cerebrovascular infarction without sequelae. CLINICAL FEATURES: A 39-year-old man with nonspecific neck pain was treated by his general practitioner with cervical manipulation. INTERVENTION AND OUTCOME: This immediately elicited severe headache and neurologic symptoms that disappeared completely within 3 months despite permanent signs of a complete left-sided cerebellar infarction on computed tomography and magnetic resonance imaging. At 7-year follow-up the patient was fully employed, and repeated magnetic resonance imaging still showed infarction of the left cerebellar hemisphere. However, the patient remained completely free of neurologic symptoms, and color duplex ultrasonography showed normal cervical vessels, including patent vertebral arteries. CONCLUSION: It appears that the risk of cerebrovascular accidents after cervical manipulation is low, considering the enormous number of treatments given each year, and very much lower than the risk of serious complications associated with generally accepted surgery. Provided there is a solid indication for cervical manipulation, we believe that the risk involved is acceptably low and that the fear of serious complications is greatly exaggerated.

Adult↗