APPLIED KINESIOLOGY RESEARCH AND LITERATURE COMPENDIUM
APPLIED KINESIOLOGY RELATED RESEARCH INFORMATION IN PEER REVIEWED JOURNALS
|
Isometric force parameters and trunk muscle recruitment
strategies in a population with low back pain, Descarreaux M, Lalonde C,
Normand MC.
|
J Manipulative Physiol Ther.
2007 Feb;30(2):91-7.
OBJECTIVE: This
study correlates changes in trunk isometric force parameters and trunk muscle
recruitment strategies in subjects with low back pain (LBP) and healthy
participants. METHODS: A control
group study with repeated measures was performed. Study participants included
15 control subjects and 14 patients with LBP. Participants were required to exert
50% and 75% of their maximal trunk flexion and extension. In a learning
phase, feedback was provided, after which study participants were asked to
perform 10 trials without any feedback. Spatiotemporal parameters of muscular
activity and force production were recorded. Dependent variables included
time to peak force, peak force variability, absolute error in peak force,
electromyogram (EMG) burst duration for agonist muscles, and normalized
integrated EMG. RESULTS: Average
time to peak force was significantly longer for subjects with LBP than for
healthy subjects. Subjects with LBP showed longer burst duration for all 4
muscles recorded. No group difference was noted in normalized integrated EMG.
CONCLUSIONS: We suggest that the
observed changes in trunk motor control and trunk muscle recruitment
strategies are not only mediated by a neurophysiologic adaptation to chronic
pain but also by cognitive adaptations modulated by fear of movement and fear
of reinjury.
|
|
Spinal muscle evaluation in healthy individuals and
low-back-pain patients: a literature review, Demoulin C, Crielaard JM, Vanderthommen M.
|
Joint
Bone Spine. 2007 Jan;74(1):9-13. Epub 2006 Nov 13.
Abstract: This article
reviews available techniques for spinal muscle investigation, as well as data
on spinal muscles in healthy individuals and in patients with low back pain.
In patients with chronic low back pain, medical imaging studies show
paraspinal muscle wasting with reductions in cross-sectional surface area and
fiber density. In healthy individuals, the paraspinal muscles contain a high
proportion of slow-twitch fibers (Type I), reflecting their role in
maintaining posture. The proportion of Type I fibers is higher in females,
leading to better adaptation to aerobic exertion compared to males.
Abnormalities seen in paraspinal muscles from patients with chronic low back
pain include marked Type II fiber atrophy, conversion of Type I to Type II
fibers, and an increased number of nonspecific abnormalities. Limited data
are available from magnetic resonance spectroscopy used to investigate muscle
metabolism and from near infrared spectroscopy used to measure oxygen uptake
by the paraspinal muscles. Surface electromyography in patients with chronic
low back pain shows increased paraspinal muscle fatigability, often with
abolition of the flexion-relaxation phenomenon.
Comment: This study
demonstrates that LBP usually correlates with demonstrable muscle changes
that will most likely to produce weakness upon testing.
|
|
EMG analysis of shoulder muscle fatigue during
resisted isometric shoulder elevation,
Minning S, Eliot CA, Uhl TL, Malone TR.
|
J
Electromyogr Kinesiol. 2006 Mar 16; [Epub ahead of print]
Abstract: The purpose
of this study was to determine if a difference existed in the rate of fatigue
of select shoulder muscles during isometric shoulder elevation and if the
measured rate of fatigue was consistent from day to day. Shoulder muscle fatigue has been associated with
alterations in joint mechanics and possibly contributes to shoulder
dysfunction. While research exists, there is limited information
on an objective and reliable measure of shoulder fatigue. Sixteen
asymptomatic subjects were evaluated. The subjects held a weight equivalent
to 60% of his/her Maximum Voluntary Isometric Contraction (MVIC) while
elevating in the scapular plane. Surface electrodes were applied to collect
electromyographic activity from the upper trapezius, middle deltoid, serratus
anterior, and lower trapezius muscles while the arm was held at 90 degrees
elevation. Data collection ceased when the subject was no longer able to
maintain 90 degrees of elevation. The subject then rested and a second trial
performed. One week later, the two-trial procedure was repeated. A
significant interaction of trialxdayxmuscle was found for the rate of
fatigue. Post hoc analysis revealed that
the rate of fatigue of the middle deltoid was significantly greater than the
other muscles tested. The intraday reliability was good for all
muscles but interday reliability was poor except for the middle deltoid. This
study suggests that the middle deltoid appears to fatigue faster than the
other shoulder muscles tested at the selected level of shoulder elevation.
This should be considered in designing a rehabilitation program to develop a
sequence that does not overly fatigue the middle deltoid.
|
|
Reversible pelvic asymmetry: an overlooked syndrome
manifesting as scoliosis, apparent leg-length difference, and neurologic
symptoms, Timgren J,
Soinila S.
|
J
Manipulative Physiol Ther. 2006 Sep;29(7):561-5.
OBJECTIVE: The objective of
this study was to investigate the occurrence of pelvic asymmetry in
neurologic patients with symptoms not explained by their neurologic
diagnosis. METHODS: We analyzed
150 consecutive neurologic patients referred to physiatric consultation based
on their clinical examination findings. RESULTS:
We observed pelvic asymmetry associated with either C-type or S-type
scoliosis and apparent leg-length difference in 87% of the patients. Symmetry
could be reestablished by all patients, although 15% showed immediate or
imminent relapse. Maintenance of symmetry showed a highly significant (P <
.001) correlation with improvement in functional ability and reduction of
pain as evaluated during the last visit to the physiatrist. In the follow-up
questionnaire, 78% of the patients reported improvement in functional ability
and reduced pain. CONCLUSIONS:
Our results support the view that leg-length difference and scoliosis may be
more often of reversible nature than previously considered. Acquired postural
asymmetry of the sacroiliac joint may be a neglected cause of several
neurologic and other pain-related symptoms that can be relieved by a simple
and safe treatment.
|
|
Effect of Counterstrain on Stretch Reflexes,
Hoffmann Reflexes, and Clinical Outcomes in Subjects With Plantar Fasciitis, Wynne MW, Burns JM, Eland
DC, Conatser RR, Howell JN.
|
JAOA Sept 2006;106(9):547-556.
Context: Previous
research indicates that osteopathic manipulative treatmentbased
on counterstrain produces a decrease in the stretch reflexof the
calf muscles in subjects with Achilles tendinitis.Objectives: To study the effects of
counterstrain on stretchreflex activity and clinical outcomes in
subjects with plantarfasciitis.Methods: In a single-blind, randomized
controlled trial of crossover design,the effects of counterstrain
were compared with those of placeboin adult subjects (N=20) with
plantar fasciitis. The subjectswere led to believe that both the
counterstrain and placebowere therapeutic modalities whose effects
were being compared.Ten subjects (50%) were assigned to receive 3
weeks of counterstraintreatment during phase 1 of the trial,
while the other 10 subjectswere given placebo capsules. After a
2- to 4-week washout period, phase2 of the trial began with the
interventions reversed. Clinicaloutcomes were assessed with daily
questionnaires. Stretch reflexand H-reflex (Hoffmann reflex) in
the calf muscles were assessedtwice during each laboratory visit,
before and after treatmentin the counterstrain phase.Results: No significant changes in the
electrically recorded reflexesof the calf muscles were observed
in response to treatment.However, changes in the mechanical
characteristics of the twitchesresulting from the electrical
responses were observed. Peakforce and time to reach peak force
both increased (P .05)
inthe posttreatment measurements, with the increase being
significantlymore pronounced in the counterstrain phase (P<.05). A comparisonof
pretreatment and posttreatment symptom severity demonstratedsignificant
relief of symptoms that was most pronounced immediatelyfollowing
treatment and lasted for 48 hours.Conclusions: Clinical improvement occurs in subjects with
plantar fasciitisin response to counterstrain treatment. The
clinical responseis accompanied by mechanical, but not
electrical, changes inthe reflex responses of the calf muscles.
The causative relationbetween the mechanical changes and the
clinical responses remainsto be explored.
|
|
A method for comparing manual muscle strength
measurements with joint moments during walking, Fosang A, Baker R.
|
Gait
Posture. 2006 Dec;24(4):406-11. Epub 2006 Jan 18.
Abstract: This paper
describes a protocol for dynamometer assisted manual muscle testing of the
major muscle groups of the lower extremity and its application to 11
able-bodied children who also had conventional gait analysis to obtain joint
kinetics. Data from the manual muscle testing was processed in such a way
that the results for maximum muscle strength (grade 5) and resistance against
gravity alone (grade 3) were presented in Nm/kg allowing direct comparison
with conventional joint kinetics. The strength measurements of the hip
muscles and the knee extensors were between two and three times the moments
exerted during normal walking. Those of the knee flexors and dorsiflexors
were about five times the joint moments. Measured plantarflexor strength was
only just greater than the moment exerted during walking. These results,
particularly those for the plantarflexors, question how valid it is to use
measures of isometric muscle strength as indicators of muscle function during
activity. The study also compares grade 3 muscle strength with both grade 5
strength and the maximum joint moments. For all muscle groups tested grade 3
muscle strength was less than the maximum moment exerted during normal
walking. For the plantarflexors it was less than 1% of that moment. The study
demonstrates that reliable isometric muscle testing is possible in
able-bodied children but requires considerable care and is time consuming.
More work is required to understand how measurements made in this way relate
to how muscles function during activity.
Comment:Many studies
have compared the findings of MMT with dynamometer tests favorably, however
dynamometers are not as sensitive to changes in strength nor to strength
measurements below 3 during the MMT. The human examiner is the most sensitive
of all instruments in relationship to interpreting the MMT.
|
Physiopathology of respiratory
muscles, Close P, Dang MN, Bury T.
(Article in French)
|
Rev Med
Liege. 2006 Apr;61(4):227-32.
Abstract: Different
factors can have deleterious effect the inspiratory muscles: increased
intrinsic mechanical loading of the inspiratory muscles, functional inspiratory muscle weakness,
increased ventilatory demand related to capacity...These muscle changes influence exercise tolerance and contribute to
dyspnea.
|
|
Conservative chiropractic
management of recalcitrant foot pain after fasciotomy: a retrospective case
review, Wyatt LH.
|
J Manipulative Physiol Ther. 2006
Jun;29(5):398-402.
OBJECTIVE: The
objective of this study was to describe the safety and potential therapeutic
benefit of joint mobilization and manipulation in the conservative management
of patients with recalcitrant foot pain after plantar fasciotomy. METHODS: The study design was a
retrospective review of outcomes of 15 patients seen in a multidisciplinary
office setting. All patients had undergone plantar fasciotomy within the 9
months before their admission and had developed lateral foot pain after
operation. Each patient had exhibited suboptimal improvement with at least a
4- to 6-week trial of nonsteroidal anti-inflammatory drugs, shoe padding, and
rest as prescribed by the attending podiatric surgeon. Manual therapy
consisted of either grade III or grade IV joint mobilization and/or
high-velocity, low-amplitude chiropractic manipulation to the affected joints
in the foot and ankle, and home-based exercise. Outcome criteria were
empirically defined as significant improvement, moderate improvement, or no
change as assessed by each patient based on a verbal rating scale. RESULTS: There was no long-lasting
complication associated with any of the procedures, although a common pattern
of transient pain migration over the dorsum of the foot into the ankle was
noted in some patients; this resolved by the time of discharge. Of the
patients with pain in the calcaneocuboid and/or fifth tarsometatarsal
articulation, 11 noted significant improvement, 3 experienced moderate
improvement, and 1 reported no change. Patients who complied with home care
instructions responded better to therapy in most instances. CONCLUSIONS: These preliminary findings
suggest that joint mobilization and manipulation are safe conservative
procedures to use in the treatment of patients with lateral column foot pain
in status post plantar fasciotomy.
Comment: When muscles
fail to support the arch of the foot the ligaments can be stretched, and the
medial longitudinal arch of the foot is lost. The many causes of foot
pronation, which produces plantar fascitis in many cases, are evaluated in AK
including the ligaments, muscles, and joints of the foot and leg.
|
|
The effect of chiropractic
adjustments on movement time: a pilot study using Fitts Law, Smith DL,
Dainoff MJ, Smith JP.
|
J Manipulative Physiol Ther.
2006 May;29(4):257-66.
OBJECTIVE: To
investigate the effect of chiropractic adjustments on movement time using
Fitts Law. METHODS: This was a prospective,
randomized controlled trial. Ten patients from a private chiropractic
practice participated. Participants in the treatment group received
high-velocity, low-amplitude chiropractic adjustments to areas of joint
dysfunction (chiropractic subluxation). A nonintervention group was used to
control for improvement resulting from time and practice effects. Movement
time was measured as participants moved a cursor onto a target appearing on a
computer screen. A range of target widths and target distances were used to
vary the index of difficulty. RESULTS:
All participants in the experimental group had significantly improved
movement times following spinal adjustments compared with only 1 participant
in the control group. The average improvement in movement time for the
experimental group was 183 ms, a 9.2% improvement, whereas the average
improvement in movement time for the control group was 29 ms, a 1.7%
improvement. The difference (improvement) scores after the intervention were
significantly greater for the chiropractic group compared with the control
group as measured by a 2-tailed independent samples t test (P < .05). CONCLUSION: The results of this study
demonstrated a significant improvement in movement time with chiropractic
care. These results suggest that spinal
adjustments may influence motor behavior.
Comment: Movement time
(MT) is an important variable influencing how people control their movements.
At the elite sport level even small changes in MT can have a large effect.
For instance, differences between the personal best times of the top
sprinters in the world in the 100 yard dash can differ by only 1% (i.e.
Greene 9.79 seconds, Bailey 9.84 s, and Christie 9.87 s). MT improvement
following treatment has been related to Parkinson’s disease severity also.
This study demonstrates another investigation into the potential motor
control and functional improvements in chiropractic patients.
|
|
Improvement in paraspinal muscle
tone, autonomic function and quality of life in four children with cerebral palsy
undergoing subluxation based chiropractic care: Four retrospective case
studies and review of the literature, McCoy M, Malakhova E, Safronov Y, Kent C,
Scire P.
|
J Vertebral Subluxation Research, June 21, 2006:1-15.
Objective: To
review the literature and present results experienced by four children with
cerebral palsy who underwent chiropractic care to reduce vertebral
subluxation. Clinical
Features: Four children previously diagnosed with cerebral palsy
secondary to birth trauma. All four demonstrated objective evidence of
vertebral subluxation. Intervention
and Outcomes: Chiropractic care directed at reduction of
subluxation was undertaken. Paraspinal surface electromyography and
thermography readings were taken prior to the initiation of care and approximately
one month (12 visits) later. The mothers and care providers in each case
monitored changes in activities of daily living and quality of life. All four
children showed improvement in paraspinal muscle tone (improved symmetry and
decreased amplitude) as well as a decrease in the number of levels of
abnormal thermography readings. All four children showed improvement in
activities of daily living including mobility, feeding, and postural control.
Conclusion:
Improvement in muscle tone and autonomic function coupled with improvement in
activities of daily living occurred in these four patients undergoing
chiropractic care for reduction of vertebral subluxation. It is suggested
that larger studies of this nature be carried out.
|
|
The effect of sacroiliac
joint manipulation on feed-forward activation times of the deep abdominal
musculature,
Marshall P, Murphy B.
|
J Manipulative Physiol Ther. 2006
Mar-Apr;29(3):196-202.
OBJECTIVES: To determine
the incidence of delayed feed-forward activation (FFA) times in a group of
healthy young males; to retest those subjects who showed delayed FFA after 6
months to determine the reliability of the measure in the absence of
treatment or injury in the intervening period; and to determine the effect of
sacroiliac joint manipulation on delayed FFA times. METHODS: Ninety young males were assessed
for the FFA of their deep abdominal muscles in relation to rapid upper limb
movements. Those who met the criteria for delayed FFA (failure of deep
abdominal activation within 50 milliseconds of deltoid activation) were then
reassessed 6 months later. These subjects then underwent sacroiliac joint
manipulation on the side demonstrating decreased joint movement during hip
flexion and lateral flexion. Feed-forward activation times were then
reassessed after joint manipulation. RESULTS:
Seventeen (18.9%) of 90 subjects met the criteria of impaired FFA. Thirteen
of 17 were available to be remeasured at 6-month follow-up. The intraclass
correlation coefficient for FFA at this time was greater than 0.70 for all
movement directions. There was a significant improvement (38.4%) in FFA times
for this group when remeasured immediately after the sacroiliac joint
manipulation. CONCLUSIONS:
Delayed FFA is a highly reproducible measure at long-term follow-up. This
technique appears to be a sensitive marker of the neural effects of
sacroiliac joint manipulation. Future prospective studies are needed to
determine if delayed FFA times are a marker for those at risk for developing
back pain.
Comment: This study
demonstrates that an immediately measurable change in muscle function and
synergism with other muscles in the body occurs after SI joint manipulation.
|
|
Whiplash injury and oculomotor dysfunctions:
clinical-posturographic correlations, Storaci R, Manelli A, Schiavone N, Mangia L, Prigione G, Sangiorgi S.
|
Eur
Spine J. 2006 Mar 22
Abstract: Oculomotor
dysfunctions are hidden causes of invalidity following whiplash injury. Many
patients with whiplash injury grade II present oculomotor dysfunctions related
to input disturbances of cervical or vestibular afferents. We used static
posturography to investigate 40 consecutive patients with whiplash injury
grade II and oculomotor dysfunctions. We demonstrated a relation between
length and surface of body sway: the surface value (A) was higher than the
length value (L) and this led to an open graph of body sway in the
statokinesigram. Oculomotor rehabilitation can resolve the impairment of
vestibular function but if therapy is delayed or the patient has been wearing
an orthopaedic neck collar, more therapeutic sessions are required. In
conclusion, without rehabilitation of the oculomotor muscles other therapies
are not sufficient to recover the impairment caused by whiplash injury.
Comment: Patients who
have experienced cervical trauma from whiplash dynamics often have perplexing
symptoms. The standard orthopedic and neurologic examination often does not
find a cause for the bizarre symptoms about which some patients complain.
Manual muscle testing is a method for evaluating the function of the nervous
system; it often reveals the cause, giving an understanding of the patient's
many complaints. Failure to recognize problems in the motor system
in whiplash patients, and failure to correct it is often the reason a patient
is labeled as being a malingerer or having a psychoneurotic overlay to his
condition, and is one of the reasons why symptoms from whiplash injuries can
persist for many years. In this report oculomotor dysfunction was present in
62% of the patients affected by whiplash injury. The opening of this paper’s
Abstract states the problem: “Oculomotor
dysfunctions are hidden causes of invalidity following whiplash injury.” In applied
kinesiology chiropractic methodology, a means for testing the integration of
the muscles in the body with the visual reflexes has been termed ocular lock. Ocular lock testing demonstrates the failure of the eyes to
work together on a binocular basis through the cardinal fields of gaze. This is usually not gross pathology of cranial
nerves III, IV, and VI; rather it is poor functional organization. The ocular
lock phenomenon is theorized to be a consequence, most frequently, to cranial
faults. Diagnosis of the oculomotor
function in patients with post-whiplash syndromes has been expedited by AK
testing.
|
|
Diagnostic accuracy of the neurological upper limb
examination I: inter-rater reproducibility of selected findings and patterns,
Jepsen JR, Laursen LH,
Hagert CG, Kreiner S, Larsen AI.
|
BMC
Neurol. 2006 Feb 16;6:8.
BACKGROUND: We have
previously assessed the reproducibility of manual testing of the strength in
14 individual upper limb muscles in patients with or without upper limb
complaints. This investigation aimed at additionally studying sensory
disturbances, the mechanosensitivity of nerve trunks, and the occurrence of
physical findings in patterns which may potentially reflect a peripheral
neuropathy. The reproducibility of this part of the neurological examination
has never been reported. METHODS:
Two blinded examiners performed a semi-quantitative assessment of 82 upper limbs (strength in 14 individual muscles,
sensibility in 7 homonymous territories, and mechanosensitivity of nerves at
10 locations). Based on the topography of nerves and their muscular and
cutaneous innervation we defined 10 neurological patterns each suggesting a
focal neuropathy. The individual findings and patterns identified by the two
examiners were compared. RESULTS:
Strength, sensibility to touch, pain and
vibration, and mechanosensitivity were predominantly assessed with moderate
to very good reproducibility (median kappa-values 0.54, 0.69, 0.48, 0.58, and
0.53, respectively). The reproducibility of the defined patterns was fair to
excellent (median correlation coefficient = 0.75) and the overall identification
of limbs with/without pattern(s) was good (kappa = 0.75). CONCLUSION: This first part of a study on
diagnostic accuracy of a selective neurological examination has demonstrated
a promising inter-rater reproducibility of individual neurological items and
patterns. Generalization and clinical feasibility require further
documentation: 1) Reproducibility in cohorts of other composition, 2)
validity with comparison to currently applied standards, and 3) potential
benefits that can be attained by the examination.
|
|
Disorders of breathing and
continence have a stronger association with back pain than obesity and
physical activity,
Smith MD Russell A, Hodges PW.
|
Aust J Physiother. 2006;52(1):11-6.
Abstract:
Although obesity and physical activity have been argued to predict
back pain, these factors are also related to incontinence and breathing
difficulties. Breathing and continence mechanisms may interfere with the
physiology of spinal control, and may provide a link to back pain. The aim of
this study was to establish the association between back pain and disorders
of continence and respiration in women. We conducted a cross-sectional
analysis of self-report, postal survey data from the Australian Longitudinal
Study on Women's Health. We used multinomial logistic regression to model
four levels of back pain in relation to both the traditional risk factors of
body mass index and activity level, and the potential risk factors of
incontinence, breathing difficulties, and allergy. A total of 38,050 women
were included from three age-cohorts. When incontinence and breathing
difficulties were considered, obesity and physical activity were not
consistently associated with back pain. In contrast, odds ratios (OR) for
often having back pain were higher for women often having incontinence
compared to women without incontinence (OR were 2.5, 2.3 and 2.3 for young,
mid-age and older women, respectively). Similarly, mid-aged and older women
had higher odds of having back pain often when they experienced breathing
difficulties often compared to women with no breathing problems (OR of 2.0
and 1.9, respectively). Unlike obesity and physical activity, disorders of
continence and respiration were strongly related to frequent back pain. This
relationship may be explained by physiological limitations of co-ordination
of postural, respiratory and continence functions of trunk muscles.
Comment: This study
confirms a frequent clinical finding in AK, i.e. that problems with
respiration involving the phrenic and intercostals nerves affect may produce
incontinence in patients. Correction of problems that produce an elevated
level of CO2 in the blood, using AK methods of treatment, can
improve the management and outcome of patients with incontinence.
|
|
A pilot study comparing
the effects of spinal manipulative therapy with those of extra-spinal
manipulative therapy on quadriceps muscle strength, Hillermann B,
Gomes AN, Korporaal C, Jackson D.
|
J Manipulative Physiol Ther, 2006
Feb;29(2):145-9.
OBJECTIVE: The
objective of this study was to assess whether tibiofemoral joint manipulation
is as effective as sacroiliac (SI) joint manipulation in increasing
quadriceps muscle strength. DESIGN AND
SETTING: Twenty subjects were divided into two groups of 10. After
all base measurements of the maximum voluntary force of the quadriceps
muscles were taken, subjects in group A received tibiofemoral joint
manipulation and those in group B received ipsilateral SI joint manipulation.
After these treatments, the maximum voluntary forces of the subjects' quadriceps
muscles were retested. RESULTS:
A significant improvement (P = .05) in quadriceps muscle strength was noted
in the subjects who received an SI joint manipulation. CONCLUSION: This study showed a
significant change within the SI joint manipulation group before and after
the manipulation but did not show any significant difference between the
groups (tibiofemoral joint vs. SI joint manipulation) in increasing
quadriceps muscle strength.
Comment: This study
demonstrates that an immediately measurable change in muscle strength, from
inhibition to strength, occurs after SI joint manipulation. A weakness in
this study’s design is that the manipulation of the tibiofemoral joint was a
long-axis manipulation of the joint. There was no evaluation done as to whether
this joint had any mechanical problem or subluxation present within it. A
more specific design would have been to compose group B of subjects who had
knee pain in the area of the tibiofemoral joint. Better yet would have been
to find subjects for group B who had specific dysfunctions of the
tibiofemoral joint. After manipulating the subluxated tibiofemoral joint into
proper position, an evaluation of the inhibited quadriceps muscle might have
found an improvement in it strength upon testing. In AK, adjustment of the
articulations of the knee frequently improves the function of the quadriceps
muscle, as does adjustment of the SI joint when it is subluxated.
|
|
A prospective randomized controlled trial of spinal
manipulation and ultrasound in the treatment of chronic low back pain,
Mohammad A, Mohseni-Bandpei, Critchley J, Staunton T, Richardson B
|
Physiotherapy 92(1) March 2006, Pages 34-42
Objectives. To assess the
short- and long-term effectiveness of spinal manipulation therapy, and to
identify the effect of manipulation on lumbar muscle endurance in patients
with chronic low back pain (LBP). Design. A
randomized controlled trial comparing manipulation and exercise treatment
with ultrasound and exercise treatment. Setting
An outpatient physiotherapy department. Participants
One hundred and twenty patients with chronic LBP were allocated at random
into the manipulation/exercise group or the ultrasound/exercise group. Interventions Both groups were given a
program of exercises. In addition, one group received spinal manipulation
therapy and the other group received therapeutic ultrasound. Main outcome measures Pain intensity,
functional disability, lumbar movements and muscle endurance were measured
shortly before treatment, at the end of the treatment program and 6 months
after randomization using surface electromyography. Results Following treatment, the
manipulation/exercise group showed a statistically significant improvement (P = 0.001) in pain intensity
[mean 16.4 mm, 95% confidence interval (CI) 6.1–26.8], functional
disability (mean 8%, 95% CI 2–13) and spinal mobility (flexion: mean
9.4 mm, 95% CI 5.5–13.4; extension: mean 3.4 mm, 95% CI 1.0–5.8).
There was no significant difference (P = 0.068)
between the two groups in the median frequency of surface electromyography
(multifidus: mean 6.8 Hz, 95% CI 1.24–14.91; iliocostalis: mean
2.4 Hz, 95% CI 2.5–7.1), although a significant difference (P = 0.013) was found in the
median frequency slope of surface electromyography in favor of spinal
manipulation for multifidus alone (mean 0.3, 95% CI 0.1–0.5). A significant
difference was also found between the two groups in favor of the
manipulation/exercise group at 6-month follow-up. Conclusions Although improvements were recorded in both
groups, patients receiving manipulation/exercise showed a greater improvement
compared with those receiving ultrasound/exercise at both the end of the
treatment period and at 6-month follow-up.
|
|
Reliability of techniques
to assess human neuromuscular function in vivo, Clark BC, Cook SB,
Ploutz-Snyder LL
|
J Electromyogr Kinesiol. 2006
Jan 18
Abstract:
The purpose of this study was to comprehensively evaluate the
reliability of a large number of commonly utilized experimental tests of in
vivo human neuromuscular function separated by 4-weeks. Numerous
electrophysiological parameters (i.e., voluntary and evoked electromyogram
[EMG] signals), contractile properties (i.e., evoked forces and rates of
force development and relaxation), muscle morphology (i.e., MRI-derived
cross-sectional area [CSA]) and performance tasks (i.e., steadiness and time
to task failure) were assessed from the plantarflexor muscle group in 17
subjects before and following 4-weeks where they maintained their normal
lifestyle. The reliability of the measured variables had wide-ranging levels
of consistency, with coefficient of variations (CV) ranging from
approximately 2% to 20%, and intraclass correlation coefficients (ICC)
between 0.53 and 0.99. Overall, we observed
moderate to high-levels of reliability in the vast majority of the variables
we assessed (24 out of the 29 had ICC>0.70 and CV<15%). The
variables demonstrating the highest reliability were: CSA (ICC=0.93-0.98),
strength (ICC=0.97), an index of nerve conduction velocity (ICC=0.95), and
H-reflex amplitude (ICC=0.93). Conversely, the variables demonstrating the
lowest reliability were: the amplitude of voluntary EMG signal
(ICC=0.53-0.88), and the time to task failure of a sustained submaximal
contraction (ICC=0.64). Additionally, relatively little systematic bias
(calculated through the limits of agreement) was observed in these measures
over the repeat sessions. In conclusion,
while the reliability differed between the various measures, in general it
was rather high even when the testing sessions are separated by a relatively
long duration of time.
|
|
Evaluation of Apparent and Absolute Supraspinatus
Strength in Patients With Shoulder Injury Using the Scapular Retraction Test,
Kibler WB, Sciascia A,
Dome D.
|
Am J
Sports Med. 2006 May 30; [Epub ahead of print]
BACKGROUND: Physical examination of patients with shoulder
injury not involving actual rotator cuff tears frequently demonstrates
decreased rotator cuff strength on manual muscle testing. This
decrease has been attributed to supraspinatus muscle weakness, but it may be
owing to alterations in scapular position. HYPOTHESIS:
The position of stabilized scapular retraction, by minimizing proximal
kinetic chain factors and providing a stable base of muscle origin,
positively influences demonstrated supraspinatus strength. STUDY DESIGN: Controlled laboratory
study. METHODS: Supraspinatus
strength was tested in 20 injured patients and 10 healthy controls in both
the empty-can arm position and a position of scapular retraction using a
handheld dynamometer. Pain in both maneuvers was measured by use of a visual
analog scale. RESULTS: Paired t
tests indicated the scapular retraction position resulted in statistically
significantly (P = .001) higher supraspinatus strength values within both
groups. There was no significant difference between the 2 positions in visual
analog scale scores. CONCLUSION:
This study shows that demonstrated apparent supraspinatus weakness on
clinical examination in symptomatic patients may be dependent on scapular
position. The weakness may be owing to other factors besides supraspinatus
muscle weakness, such as a lack of a stable base in the kinetic chain or
scapula. CLINICAL RELEVANCE: The
clinical examination that addresses scapular posture and includes scapular
retraction will allow more accurate determination of absolute supraspinatus
muscle strength and allow efficacious rehabilitation protocols to address the
source of the demonstrated weakness.
Comment: In AK,
precise positioning of the patient is critical to consistently dependable findings
in MMT. There are many synergistic muscles to the muscle being primarily
evaluated during MMT, and these muscles must be correlated to make final
determination of the muscle’s function. Proper muscle testing is the key to
an effective examination. Poor or inexact testing may result in
misinformation or in the wrong choice of therapies.
|
|
The visceromotor responses to colorectal distension
and skin pinch are inhibited by simultaneous jejunal distension, Shafton AD, Furness JB, Ferens D, Bogeski
G, Koh SL, Lean NP, Kitchener PD.
|
Pain. 2006 Jul;123(1-2):127-36.
Epub 2006 May 16.
Abstract: Noxious
stimuli that are applied to different somatic sites interact; often one
stimulus diminishes the sensation elicited from another site. By contrast,
inhibitory interactions between visceral stimuli are not well documented. We
investigated the interaction between the effects of noxious distension of the
colorectum and noxious stimuli applied to the jejunum, in the rat. Colorectal
distension elicited a visceromotor reflex, which was quantified using
electromyographic (EMG) recordings from the external oblique muscle of the
upper abdomen. The same motor units were activated when a strong pinch was
applied to the flank skin. Distension of the jejunum did not provoke an EMG
response at this site, but when it was applied during colorectal distension
it blocked the EMG response. Jejunal distension also inhibited the response
to noxious skin pinch. The inhibition of the visceromotor response to
colorectal distension was prevented by local application of tetrodotoxin to
the jejunum, and was markedly reduced when nicardipine was infused into the
local jejunal circulation. Chronic sub-diaphragmatic vagotomy had no effect
on the colorectal distension-induced EMG activity or its inhibition by
jejunal distension. The nicotinic antagonist hexamethonium suppressed phasic
contractile activity in the jejunum, had only a small effect on the
inhibition of visceromotor response by jejunal distension. It is concluded
that signals that arise from skin pinch and colorectal distension converge in
the central nervous system with pathways that are activated by jejunal spinal
afferents; the jejunal signals strongly inhibit the abdominal motor activity
evoked by noxious stimuli.
|
|
Measurement of electrical skin impedance of
dermal-visceral zones as a diagnostic tool for inner organ pathologies: a
blinded preliminary evaluation of a new technique, Zimlichman E,
Lahad A, Aron-Maor A
Kanevsky A, Shoenfeld Y.
|
Isr Med
Assoc J. 2005 Oct;7(10):631-4
BACKGROUND: As
complementary and alternative medicine is gaining popularity among health
consumers, diagnostic screening tools based on neuroreflexology are also
being developed. These techniques, which are based on the rationale that
measurement of electrical impedance of specific dermatomes reflects
corresponding internal organ pathologies, have not yet been the subject of
conventional scientific research. OBJECTIVES:
To determine the effectiveness of a neuroreflexology-based screening test,
specifically the Medex device (Medex Screen Ltd.), for diagnosing patients
undergoing conventional internal organ assessment, in a hospital setting.
METHODS: Patients admitted to an internal medicine department, who met the
inclusion criteria and agreed to participate, underwent conventional medical
evaluation that included past medical history and physical examination.
Another examination was conducted by a second physician using the Medex
device to determine internal organ pathologies. A third researcher compared
the actual "conventional" diagnosis with the Medex device output
using standard statistical analysis. RESULTS:
Overall, 150 patients participated in the study. Correlation was significant
for all categories (P < 0.01) except for blood and lymphatic disease. A
high sensitivity (>70%) was measured for cardiovascular, respiratory,
gastrointestinal and genitourinary diseases. The highest measure of
agreement, as represented by the Cohen-Kappa factor, was found for
respiratory disease (0.57). CONCLUSIONS:
Although the exact mechanism is not entirely clear, measurement of
electroskin impedance of dermal-visceral zones has the potential to serve as
a screening tool for inner organ pathologies. Further research should be
conducted to create more evidence to support or dispute the use of this
technique as a reliable diagnostic tool.
Comment: This study
demonstrates a small part of the potentiality of the AK technique called
Therapy Localization or TL. In AK, TL is a simple, non-invasive technique to
find out where a problem in the body exists. TL doesn’t show the physician
what the problem is but shows that something under the hand that is
contacting the patient’s body is disturbing the nervous system.
|
|
Modulation of intracortical excitability in human
hand motor areas. The effect of cutaneous stimulation and its topographical
arrangement, Ridding
MC, Pearce SL, Flavel SC.
|
Exp
Brain Res. 2005 Jun;163(3):335-43. Epub 2005 Jan 15
Abstract: Changes in
afferent input can alter the excitability of intracortical inhibitory systems.
For example, using paired transcranial magnetic stimulation (TMS), both
electrical digital stimulation and muscle vibration have been shown to reduce
short-interval intracortical inhibition (SICI). The effects following muscle
vibration are confined to the corticospinal projection to the vibrated
muscles. The results following digital stimulation are less clear and the
relative timing of the cutaneous stimulation and TMS is critical. Here we
investigated further whether changes in SICI following digit stimulation
exhibit topographic specificity. Eleven normal subjects were investigated
(age 28.2+/-7.5 years, mean+/-SD). Electromyographic recordings were made
from the right first dorsal interosseous (FDI), abductor digiti minimi (ADM)
and abductor pollicis brevis (APB) muscles. SICI was measured, with and
without preceding electrical digit II or digit V cutaneous stimulation. The
interval between the digital nerve stimulus and test magnetic stimulus was
independently set for each subject and established by subtracting the onset
latency of the motor evoked potential (MEP) from the latency of the E2
component of the cutaneomuscular reflex. Therefore, measures of intracortical
excitability were made at a time at which it is known that cutaneous input is
capable of modulating cortical excitability. Single digital nerve stimuli
applied to digit II significantly reduced SICI in FDI but not in ADM. Single
digital nerve stimuli applied to digit V significantly reduced SICI in ADM
but not in FDI or APB. There was a more generalised effect on intracortical
facilitation (ICF) with both digit II and digit V stimulation significantly
increasing ICF in FDI and ADM. Digital stimulation (either DII or DV) did not
significantly affect SICI/ICF in APB. These findings show that appropriately
timed cutaneous stimuli are capable of modulating SICI in a topographically
specific manner. We suggest that the selective decrease in SICI seen with
cutaneous stimulation may be important for focusing of muscle activation
during motor tasks.
Comment: This study
demonstrates also a small part of the potentiality of the AK technique called
Therapy Localization or TL. The cutaneomuscular reflexes have been
extensively investigated in the scientific literature, and they are part of
the mechanism for what is found clinically with TL testing.
|
|
Delayed trunk muscle
reflex responses increase the risk of low back injuries, Cholewicki J,
Silfies SP, Shah R, Greene HS, Reeves NP, Alvi K, Goldberg B
|
Spine. 2005 Dec
1;30(23):2614-20.
STUDY
DESIGN: Prospective observational study with a 2- to
3-year follow-up. OBJECTIVES: To
determine whether delayed muscle reflex response to sudden trunk loading is a
result of or a risk factor for sustaining a low back injury (LBI). SUMMARY OF BACKGROUND DATA: Differences in
motor control have been identified in individuals with chronic low back pain
and in athletes with a history of LBI when compared with controls. However,
it is not known whether these changes are a risk for or a result of LBI. METHODS: Muscle reflex latencies in
response to a quick force release in trunk flexion, extension, and lateral
bending were measured in 303 college athletes. Information was also obtained
regarding their personal data, athletic experience, and history of LBI. The
data were entered into a binary logistic regression model to identify the
predictors of future LBI. RESULTS:
A total of 292 athletes were used for the final analysis (148 females and 144
males). During the follow-up period, 31 (11%) athletes sustained an LBI. The
regression model, consisting of history of LBI, body weight, and the latency
of muscles shutting off during flexion and lateral bending load releases,
predicted correctly 74% of LBI outcomes. The odds of sustaining LBI increased
2.8-fold when a history of LBI was present and increased by 3% with each
millisecond of abdominal muscle shut-off latency. On average, this latency
was 14 milliseconds longer for athletes who sustained LBI in comparison to
athletes who did not sustain LBI (77 [36] vs. 63 [31]). There were no significant
changes in any of the muscle response latencies on retest following the
injury. CONCLUSIONS: The delayed
muscle reflex response significantly increases the odds of sustaining an LBI.
These delayed latencies appear to be a preexisting risk factor and not the
effect of an LBI.
|
|
Trunk muscle recruitment
patterns in specific chronic low back pain populations, Silfies SP,
Squillante D, Maurer P, Westcott S, Karduna AR.
|
Clin Biomech (Bristol, Avon). 2005
Jun;20(5):465-73.
BACKGROUND: It is hypothesized that injury or degeneration of
osteoligamentous spinal structures would require compensation by trunk
musculature and alterations in motor control to maintain spine stability.
While, biomechanical modeling has supported this hypothesis, studies of
muscle recruitment patterns in chronic low back pain patients both with and
without significant osteoligamentous damage have been limited. This study
utilized a non-randomized case-control design to investigate trunk muscle
recruitment patterns around the neutral spine position between subgroups of
patients with chronic mechanical low back pain and asymptomatic controls.
METHODS: Twenty subjects with chronic low back pain attributed to clinical
lumbar instability were matched to 20 asymptomatic controls. In addition 12
patients with non-specific chronic low back pain were studied. Surface EMG
from five trunk muscles was analyzed to determine activation levels and
patterns of recruitment during a standing reach under two different loading
conditions. FINDINGS: The chronic low back
pain group with symptoms attributed to clinical instability demonstrated
significantly higher activation levels of the external oblique and rectus
abdominus muscles and lower abdominal synergist ratios than the control
group. No significant differences were found between patient
subgroups. INTERPRETATION: While these data
demonstrate altered muscle recruitment patterns in patients with chronic low
back pain, the changes are not consistent with Panjabi's theory
suggesting that these alterations are driven by passive subsystem damage. However, the higher activation of global abdominal
musculature and altered synergist patterns may represent a motor control
pattern that has consequences for continued dysfunction and chronic pain.
Comment: In this
compendium of evidence for the AK approach to health care there have been
more than 20 studies documenting that motor control does not function
properly in patients with chronic LBP and neck pain. This type of muscular
dysfunction, recognized as critical in patients with LBP and neck pain,
involves the disruption of the what Dr. Panjabi terms the stability system of
the spine, leading to the suggestion that improper stabilization responses
may serve as a perpetuating factor in patients. It would therefore be
beneficial for clinicians to have at their disposal simple, reliable, and
accurate tests that are capable of detecting the disturbance of these motor
control responses and of monitoring the effectiveness of treatment measures
designed to correct this dysfunction. AK MMT provides this type of simple,
reliable, repeatable physical test.
|
|
A model of
dynamic sacro–iliac joint instability from malrecruitment of gluteus maximus
and biceps femoris muscles resulting in low back pain, Hossain M, Nokes LDM.
|
Medical
Hypotheses,
2005;65(2):278-281.
Abstract:The objective of this work is to propose a biomechanical model of sacro–iliac joint dysfunction as a cause of low back pain. Sacro–iliac joint is known to be a source of low back pain. We also know that it is a very stable joint with little mobility. Surrounding lower limb and back muscles contribute a major part of this stability. Gait analysis studies have revealed an orderly sequence of muscle activation when we walk – that contributes to efficient stabilisation of the joint and effective weight transfer to the lower limb. Gluteus maximus fibres-lying almost perpendicular to the joint surfaces are ideally oriented for this purpose. Biceps femoris is another important muscle that can also influence joint stability by its proximal attachment to sacrotuberous ligament. Altered pattern of muscle recruitment has been observed in patients with low back pain. But we do not know the exact cause–effect relationship. Because of its position as a key linkage in transmission of weight from the upper limbs to the lower, poor joint stability could have major consequences on weight bearing. It is proposed that sacro–iliac joint dysfunction can result from malrecruitment of gluteus maximus motor units during weight bearing. This results in compensatory biceps over activation. The resulting soft tissue strain and joint instability may manifest itself in low back pain. If our hypothesis holds true, it may have positive implications for patients with sacro–iliac joint dysfunction – who could be offered a definite diagnosis and targeted physiotherapy. It may be possible to identify patients early in a primary care setting and offer direct physio referral. They could benefit from exercises to improve strengthening and recruitment of the affected muscles. |
|
Effect of gaze direction
on neck muscle activity during cervical rotation, Bexander CS, Mellor
R, Hodges PW.
|
Exp Brain Res.
2005 Dec;167(3):422-32. Epub 2005 Sep 29.
Abstract: Control of the neck muscles is coordinated with the
sensory organs of vision, hearing and balance. For instance,
activity of splenius capitis (SC) is modified with gaze shift. This
interaction between eye movement and neck muscle activity is likely to
influence the control of neck movement. The aim of this study was to
investigate the effect of eye position on neck muscle activity during
cervical rotation. In eleven subjects we recorded electromyographic activity
(EMG) of muscles that rotate the neck to the right [right obliquus capitis
inferior (OI), multifides (MF), and SC, and left sternocleidomastoid (SCM)]
with intramuscular or surface electrodes. In sitting, subjects rotated the
neck in each direction to specific points in range that were held statically
with gaze either fixed to a guide (at three different positions) that moved
with the head to maintain a constant intra-orbit eye position or to a panel
in front of the subject. Although right SC and left SCM EMG increased with
rotation to the right, contrary to anatomical texts, OI EMG increased with
both directions and MF EMG did not change from the activity recorded at rest.
During neck rotation SCM and MF EMG was less when the eyes were maintained
with a constant intra-orbit position that was opposite to the direction of
rotation compared to trials in which the eyes were maintained in the same
direction as the head movement. The
inter-relationship between eye position and neck muscle activity may affect
the control of neck posture and movement.
Comment: In applied
kinesiology chiropractic methodology, a means for testing the integration of
the muscles in the body with the visual reflexes has been termed ocular lock. It demonstrates the failure
of the eyes to work together on a binocular basis through the cardinal fields
of gaze. This is usually not gross pathology
of cranial nerves III, IV, and VI; rather it is poor functional organization.
Mechanical irritation of cranial nerves III, IV, or VI (usually VI) may be
responsible for disturbed binocular function leading to discordant sensory
inputs from the visual righting reflex. When the eyes are turned in a
specific direction, a previously strong indicator muscle will weaken when the
ocular lock test is positive. AK evaluation makes the discovery of
dysfunction between the movement of the eyes and their coordination with the
muscles of the neck possible in the clinical setting.
|
|
Myotendinous alterations
and effects of resistive loading in old age, Narici M, Maganaris C,
Reeves N.
-- Institute for Biophysical and Clinical Research
into Human Movement (IRM), Manchester Metropolitan University
|
Scand J Med Sci Sports. 2005
Dec;15(6):392-401.
Abstract: The loss of
muscle mass associated with ageing only partly explains the observed decline
in muscle strength. This paper provides evidence of the contribution of muscular,
tendinous and neural alterations to muscle weakness in old age and discusses
the complex interplay between the changes of the contractile tissue with
those of the tendinous tissue in relation to the mechanical behavior of the
muscle as a whole. Despite the considerable structural and functional
alterations, the elderly musculoskeletal system displays remarkable
adaptability to training in old age and many of these adverse effects may be
substantially mitigated, if not reversed, by resistive loading. The interplay
between these muscular and tendinous adaptations has an impact both on the
length-force and force-velocity relationships of the muscle and is likely to
affect the range of motion, rate of force development, maximum force
development and speed of movement of the older individual.
|
|
Erector Spinae and Quadratus Lumborum Muscle
Endurance Tests and Supine Leg-Length Alignment Asymmetry: An Observational
Study, Knutson, G., Owens, E.
|
J Manipulative Physiol Ther,
2005;28(8):575-581
Objective: To determine if there is
an association between supine leg-length alignment (LLA) asymmetry and the
endurance of the erector spinae (ES) and quadratus lumborum (QL) muscles. Methods: Forty-seven subjects (21 women; average
age, 36 years old) were tested for ES endurance using the Biering-Sorensen
(B-S) test, and 69 (31 women; average age, 34.5 years) were tested for QL
endurance. Subjects were examined for supine LLA and tested for ES and QL
muscle endurance. The muscle endurance times were compared against those who
did and did not demonstrate LLA asymmetry and the side of the “short leg.” Results: In the B-S test, volunteers with LLA
asymmetry (n = 27) had a mean endurance time of 89.7 seconds (SD, 43.3), and
the no-LLA asymmetry group (n = 20) had a mean endurance time of 161.5
seconds (SD, 57.1), a significant difference (P < .001). In the QL test,
after correction for the effects of sex and exercise, those with a right
“short leg” (n = 22) had a right QL endurance time of 25.9 seconds (SE, 4.2)
and a left QL endurance time of 34.7 seconds (SE, 4.3). The right QL
endurance time was significantly different from those subjects with balanced
legs (P = .001). Those with a left “short leg” (n = 20) had a left QL
endurance time of 28.6 seconds (SE, 4.7) and a right QL endurance time of
38.1 seconds (SE, 4.5). Both QL endurance times were significantly different
from those with balanced leg-length (P = .002 and .016, respectively). Conclusion: This study suggests that, using the B-S
test, the group of volunteers who demonstrated a commonly used sign of
subluxation/joint dysfunction, supine LLA asymmetry, had a decreased
endurance times over those who did not. The QL endurance tests showed that
the QL muscle ipsilateral to the supine short leg had significantly decreased
endurance times over the same-side QL fatigue times in the no leg-length
asymmetry group.
|
|
Spinal
manipulation alters electromyographic activity of paraspinal muscles: a
descriptive study, DeVocht J, Pickar J, Wilder D.
|
J Manipulative Physiol Ther, 2005;28(7):465-471
Objective: To examine the effect of spinal
manipulation on electromyographic (EMG) activity in areas of localized tight
muscle bundles of the low back.Methods: Surface EMG activity was collected from 16
participants in 2 chiropractic offices during the 5 to 10 minutes of the
treatment protocol. Electrodes were placed over the 2 sites of greatest
paraspinal muscle tension as determined by manual palpation. Spinal
manipulation was administered to 8 participants using Activator protocol; the
other 8 were treated using Diversified protocol. Results:
Electromyographic
activity decreased by at least 25% after treatment in 24 of the 31 sites that
were monitored. There was less than 25% change at 3 sites and more than 25%
increase at 4 sites. Multiple distinct increases and decreases were observed
in many data plots.Conclusion: The results of this study
indicate that manipulation induces a virtually immediate change, usually a
reduction, in resting EMG levels in at least some patients with low back pain
and tight paraspinal muscle bundles. In some cases, EMG activity increased
during the treatment protocol and then usually, but not always, decreased to
a level lower than the pretreatment level.
|
|
A hypothesis of chronic back pain: ligament
subfailure injuries lead to muscle control dysfunction, Panjabi M.
|
Eur Spine J. 2005
Jul 27
Abstract: Clinical
reports and research studies have documented the behavior of chronic low back
and neck pain patients. A few hypotheses have attempted to explain these
varied clinical and research findings. A new hypothesis, based upon the
concept that subfailure injuries of ligaments (spinal ligaments, disc annulus
and facet capsules) may cause chronic back pain due to muscle control
dysfunction, is presented. The hypothesis has the following sequential steps.
Single trauma or cumulative microtrauma causes subfailure injuries of the
ligaments and embedded mechanoreceptors. The injured mechanoreceptors
generate corrupted transducer signals, which lead to corrupted muscle response
pattern produced by the neuromuscular control unit. Muscle coordination and
individual muscle force characteristics, i.e. onset, magnitude, and shut-off,
are disrupted. This results in abnormal stresses and strains in the
ligaments, mechanoreceptors and muscles, and excessive loading of the facet
joints. Due to inherently poor healing of spinal ligaments, accelerated
degeneration of disc and facet joints may occur. The abnormal conditions may
persist, and, over time, may lead to chronic back pain via inflammation of
neural tissues. The hypothesis explains many of the clinical observations and
research findings about the back pain patients. The hypothesis may help in a
better understanding of chronic low back and neck pain patients, and in
improved clinical management.
Comment: This is one
of the most important articles published to date on the musculoskeletal
aspects of the subluxation. Dr. Panjabi is the world’s most published human
biomechanical researcher, with 263 published articles to date. The hypothesis
he presents in this paper places the functionality of muscles, as both a
cause and a consequence of mechanoreceptor dysfunction in chronic back pain
patients, at the center of a sequence of events that ultimately results in
back pain. As a result of spinal subluxations, muscle coordination and
individual muscle force characteristics, i.e. inhibited muscles on MMT, are
disrupted. The injured mechanoreceptors generate corrupted transducer signals
(that could be detected by EMG, dynamometers, or MMT), which lead to
corrupted muscle response patterns produced by the neuromuscular control
unit. This article is very important
for those in the chiropractic profession who are evaluating the existence and
the consequences of the subluxation. The key technical factor that makes AK
indispensable in the detection of spinal dysfunction is the MMT that makes
the detection of muscular imbalance verifiable.
|
|
Parallel comparison of grip strength measures
obtained with a MicroFET 4 and a Jamar dynamometer, Bohannon RW.
-- Department of Physical Therapy, School of
Allied Health, U-2101, University of Connecticut, Storrs, CT 06269-2101, USA.
|
Percept Mot Skills. 2005 Jun;100(3 Pt 1):795-8.
Abstract:Repeated measures of grip strength obtained
bilaterally with a Jamar and a MicroFET 4 dynamometer were compared.
Measurements obtained with the MicroFET 4 tended to be slightly (2.2-3.1 lb.)
higher but were highly correlated (r > or = .96) with those obtained with
the Jamar. Parallel reliability for the two devices was excellent (intraclass
correlation coefficient > or = .96). Although clinicians should be
cautious about using the devices interchangeably, the MicroFET 4 appears to
be a legitimate alternative to the Jamar dynamometer.
|
|
Quantifying shoulder rotation weakness in patients
with shoulder impingement, Tyler TF, Nahow RC, Nicholas SJ, McHugh MP.
-- Nicholas
Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New
York, NY, USA; PRO Sports Physical Therapy of Westchester, New York, NY, USA.
|
J Shoulder Elbow Surg.
2005 Nov-Dec;14(6):570-4.
Abstract: The purpose
of this study was to determine whether strength deficits could be detected in
individuals with and without shoulder impingement, all of whom had normal
shoulder strength bilaterally according to grading of manual muscle testing.
Strength of the internal rotators and external rotators was tested
isokinetically at 60 degrees /s and 180 degrees /s, as well as manually with
a handheld dynamometer (HHD) in 17 patients and 22 control subjects. Testing
was performed with the shoulder positioned in the scapular plane and in 90
degrees of shoulder abduction with 90 degrees of elbow flexion (90-90). The
peak torque was determined for each movement. The strength deficit between
the involved and uninvolved arms (patients) and the dominant and nondominant
arms (control subjects) was calculated for each subject. Comparisons were
made for the scapular-plane and 90-90 positions between isokinetic and HHD
testing. Despite a normal muscle grade, patients had marked weakness (28%
deficit, P < .01) in external rotators at the 90-90 position tested with
the HHD. In contrast, external rotator weakness was not evident with
isokinetic testing at the 90-90 position (60 degrees /s and 180 degrees /s,
0% deficit, P = .99). In control subjects, greater internal rotator strength
in the dominant compared with the nondominant arm was evident with the HHD at
the 90-90 position (11%, P < .01) and in the scapular plane (7%, P <
.05). Using an HHD while performing manual muscle testing can quantify
shoulder strength deficits that may not be apparent with isokinetic testing.
By using an HHD during shoulder testing, clinicians can identify weakness
that may have been presumed normal.
|
|
Scapular muscle tests in subjects with shoulder pain
and functional loss: reliability and construct validity, Michener LA, Boardman ND, Pidcoe PE, Frith
AM.
|
Phys
Ther. 2005 Nov;85(11):1128-38.
BACKGROUND
AND PURPOSE: Scapular muscle performance evaluated with a
handheld dynamometer (HHD) has been investigated only in people without
shoulder dysfunction for test-retest reliability of data obtained with a
single scapular muscle test. The purpose of this study was to assess the
reliability, error, and validity of data obtained with an HHD for 4 scapular
muscle tests in subjects with shoulder pain and functional loss. SUBJECTS AND METHODS: Subjects (N=40)
with shoulder pain and functional loss were tested by measuring the kilograms
applied with an HHD during 3 trials for muscle tests for the lower trapezius,
upper trapezius, middle trapezius, and serratus anterior muscles.
Concurrently, surface electromyography (sEMG) data were collected for the 4
muscles. The same procedures were performed 24 to 72 hours after the initial
testing by the same tester. Muscle tests were performed 3 times, and the
results were averaged for data analysis. RESULTS:
Intraclass correlation coefficients for
intratester reliability of measurements of isometric force obtained using an
HHD ranged from .89 to .96. The standard error of the measure (90%
confidence interval [CI]) ranged from 1.3 to 2.7 kg; the minimal detectable
change (90% CI) ranged from 1.8 to 3.6 kg. Construct validity assessment,
done by comparing the amounts of isometric muscle activity (sEMG) for each
muscle across the 4 muscle tests, revealed that the muscle activity of the
upper trapezius and lower trapezius muscles was highest during their
respective tests. Conversely, the isometric muscle activity of the middle
trapezius and serratus anterior muscles was not highest during their
respective tests. DISCUSSION AND
CONCLUSION: In people with shoulder pain and functional loss, the
intrarater reliability and error over 1 to 3 days were established using an
HHD for measurement of isometric force for the assessment of scapular muscle
performance. Error values can be used to make decisions regarding individual
patients. Construct validity was established for the lower and upper
trapezius muscle tests; therefore, these tests are advocated for use.
However, construct validity was not demonstrated for the serratus anterior
and middle trapezius muscle tests as performed in this study. Further
investigation of these muscle tests is warranted.
Comment: The
correlation between MMT and HHD findings has been established in much of the
research literature. This paper shows that there is a construct validity and
reliability to employing MMT and HHD testing in patients with shoulder
injuries.
|
|
Hip muscle weakness and
overuse injuries in recreational runners, Niemuth PE, Johnson RJ,
Myers MJ, Thieman TJ.
|
Clin J Sport Med.
2005 Jan;15(1):14-21.
OBJECTIVE: To test for
differences in strength of 6 muscle groups of the hip on the involved leg in
recreational runners with injuries compared with the uninvolved leg and a
control group of noninjured runners. DESIGN:
Descriptive analysis. SETTING:
Three outpatient physical therapy clinics in the Minneapolis/St. Paul
metropolitan area. PARTICIPANTS:
Thirty recreational runners (17 female, 13 male) experiencing a single leg
overuse injury that presented for treatment between June and September 2002.
Thirty noninjured runners (16 female, 14 male) randomly selected from a pool
of 46 volunteers from a distance running club served as controls. MAIN OUTCOME MEASURES: Self-report
demographic information on running habits, leg dominance demonstrated by
preferred kicking leg, and injury information. Muscle strength of the 6 major
muscle groups of the hip was recorded using a hand-held dynamometer. The
highest value of 2 trials was used, and strength values were normalized to
body mass(2/3). RESULTS: Results
comparing the injured and noninjured groups showed that leg dominance did not
influence the leg of injury (chi(2)(1) = 0.134; P = 0.71). Correlations for internal reliability of muscle
measurements between trials 1 and 2 with the hand-held dynamometer ranged
from 0.80 to 0.90 for the 6 muscle groups measured, and all P values were
less than 0.0001. No significant side-to-side differences in hip
group muscle strength were found in the noninjured runners (P = 0.62-0.93). Among the injured runners, the injured side hip
abductor (P = 0.0003) and flexor muscle groups (P = 0.026) were significantly
weaker than the noninjured side. In addition, the injured side hip adductor
muscle group was significantly stronger (P = 0.010) than the noninjured side.
Duration of symptoms was not a contributing factor to the extent of injury as
measured by muscle strength imbalance between injured and uninjured sides. CONCLUSIONS: Although no cause-and-effect
relationship has been established, this
is the first study to show an association
between hip abductor, adductor, and flexor muscle group strength imbalance
and lower extremity overuse injuries in runners. Because most
running injuries are multifaceted in nature, areas secondary to the site of
pain, such as hip muscle groups exhibiting strength imbalances, must also be
considered to gain favorable outcomes for injured runners. The addition of strengthening exercises to
specifically identified weak hip muscles may offer better treatment results
in patients with running injuries.
Comment: This study
shows an important evidence-based component of the treatment of hip and
pelvic problems in runners as being methods of strengthening the weak muscles
around the hip and to improve muscular balance, the sine qua non of AK treatment.
|
|
Long-term follow-up of a
randomized clinical trial assessing the efficacy of medication, acupuncture,
and spinal manipulation for chronic mechanical spinal pain syndromes, Muller
R, Giles LG.
|
J Manipulative Physiol Ther.
2005 Jan;28(1):3-11.
OBJECTIVE: To assess
the long-term benefits of medication, needle acupuncture, and spinal
manipulation as exclusive and standardized treatment regimens in patients
with chronic (>13 weeks) spinal pain syndromes. STUDY DESIGN: Extended follow-up (>1 year) of a
randomized clinical trial was conducted at the multidisciplinary spinal pain
unit of Townsville's General Hospital between February 1999 and October 2001.
PATIENTS AND METHODS: Of the 115
patients originally randomized, 69 had exclusively been treated with the
randomly allocated treatment during the 9-week treatment period (results at 9
weeks were reported earlier). These patients were followed up and assessed
again 1 year after inception into the study reapplying the same instruments
(i.e., Oswestry Back Pain Index, Neck Disability Index, Short-Form-36, and
Visual Analogue Scales). Questionnaires were obtained from 62 patients
reflecting a retention proportion of 90%. The main analysis was restricted to
40 patients who had received exclusively the randomly allocated treatment for
the whole observation period since randomization. RESULTS: Comparisons of initial and extended follow-up
questionnaires to assess absolute efficacy showed that only the application
of spinal manipulation revealed broad-based long-term benefit: 5 of the 7
main outcome measures showed significant improvements compared with only 1
item in each of the acupuncture and the medication groups. CONCLUSIONS: In patients with chronic spinal
pain syndromes, spinal manipulation, if not contraindicated, may be the only
treatment modality of the assessed regimens that provides broad and
significant long-term benefit.
|
|
Muscle reflex
classification of low-back pain, Reeves NP, Cholewicki J, Milner TE.
|
J Electromyogr Kinesiol.
2005 Feb;15(1):53-60. Epub 2004 Nov 21.
Abstract: It has been
well documented that low-back pain (LBP) patients have longer muscle response
latencies to perturbation than healthy controls. These muscle responses
appear to be reflexive and not voluntary in nature, and as a result, might be
useful for objectively classifying LBP. The goal of the study was to develop
an objective and accurate method for classifying LBP using a sudden
load-release protocol. Subjects were divided into two groups: learning group (20
patients and 20 controls), and holdout group (15 patients and 12 controls).
Subjects exerted isometric trunk force against a cable in four different
directions. Following cable release, the trunk was suddenly displaced
eliciting a muscle reflex response. Reflex latencies for muscles switching-on
and shutting-off were determined using electromyogram signals from 8 trunk
muscles. Independent t tests were performed on the learning group to
determine which reflex parameters were to be entered into logistic regression
analysis to produce a classification model. The holdout group was used to
validate this classification model. The three-parameter model was able to
correctly classify 83% of the learning group, and 81% of the holdout group. Using reflex parameters appears to be an accurate
and objective method for classifying LBP.
|
|
Motor unit synchronization
is reduced in anterior knee pain,
Mellor R, Hodges PW.
|
J Pain. 2005
Aug;6(8):550-8.
Abstract:
Anterior knee pain (AKP) is common and has been argued to be related
to poor patellofemoral joint control due to impaired coordination of the
vasti muscles. However, there are conflicting data. Changes in motor unit
firing may provide more definitive evidence. Synchronization of motor unit
action potentials (MUAPs) in vastus medialis obliquus (VMO) and vastus
lateralis (VL) may contribute to coordination in patellofemoral joint
control. We hypothesized that synchronization may be reduced in AKP.
Recordings of single MUAPs were made from VMO and multiunit electromyograph
(EMG) recordings were made from VL. Averages of VL EMG recordings were
triggered from the single MUAPs in VMO. Motor units in VL firing in
association with the VMO motor units would appear as a peak in the VL EMG
average. Data were compared to previous normative data. The proportion of
trials in which a peak was identified in the triggered averages of VL EMG was
reduced in people with AKP (38%) compared to controls (90%). Notably,
although 80% of subjects had values less than controls, 20% were within normal
limits. These results provide new evidence that motor unit synchronization is
modified in the presence of pain and provide evidence for motor control
dysfunction in AKP. PERSPECTIVE: This study
shows that coordination of motor units between the medial and lateral vasti
muscles in people with anterior knee pain is reduced compared to people
without knee pain. It confirms that motor control dysfunction is a factor in
this condition and has implications for selection of rehabilitation
strategies.
Comment: This study
suggests that in some cases, correcting knee pain is often as simple as
correcting the muscles that stabilize the knee. AK evaluation of knee
dysfunction always involves testing the knee-supporting muscles’ function.
|
|
Chronic spinal pain: a randomized
clinical trial comparing medication, acupuncture, and spinal manipulation, Giles
LG, Muller R.
|
Spine. 2005 Jan
1;30(1):166.
STUDY
DESIGN: A randomized controlled clinical trial was
conducted. OBJECTIVE: To compare
medication, needle acupuncture, and spinal manipulation for managing chronic
(>13 weeks duration) spinal pain because the value of medicinal and
popular forms of alternative care for chronic spinal pain syndromes is
uncertain. SUMMARY OF BACKGROUND DATA: Between
February 1999 and October 2001, 115 patients without contraindication for the
three treatment regimens were enrolled at the public hospital's
multidisciplinary spinal pain unit. METHODS:
One of three separate intervention protocols was used: medication, needle
acupuncture, or chiropractic spinal manipulation. Patients were assessed
before treatment by a sports medical physician for exclusion criteria and by
a research assistant using the Oswestry Back Pain Disability Index
(Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey
questionnaire (SF-36), visual analog scales (VAS) of pain intensity and
ranges of movement. These instruments were administered again at 2, 5, and 9
weeks after the beginning of treatment. RESULTS:
Randomization proved to be successful. The highest proportion of early
(asymptomatic status) recovery was found for manipulation (27.3%), followed
by acupuncture (9.4%) and medication (5%). Manipulation achieved the best
overall results, with improvements of 50% (P = 0.01) on the Oswestry scale, 38%
(P = 0.08) on the NDI, 47% (P < 0.001) on the SF-36, and 50% (P < 0.01)
on the VAS for back pain, 38% (P < 0.001) for lumbar standing flexion, 20%
(P < 0.001) for lumbar sitting flexion, 25% (P = 0.1) for cervical sitting
flexion, and 18% (P = 0.02) for cervical sitting extension. However, on the
VAS for neck pain, acupuncture showed a better result than manipulation (50%
vs. 42%). CONCLUSIONS: The consistency of the results provides, despite
some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation,
if not contraindicated, results in greater short-term improvement than
acupuncture or medication. However, the data do not
strongly support the use of only manipulation, only acupuncture, or only
nonsteroidal anti-inflammatory drugs for the treatment of chronic spinal
pain. The results from this exploratory study need confirmation from future
larger studies.
|
|
Navigating a sensorimotor loop, Fanselow EE, Connors BW.
|
Neuron. 2005 Feb 3;45(3):329-30.
Abstract: Touch is an
active process, but how do the body's somatic sensors influence its movement?
In this issue of Neuron, Nguyen and Kleinfeld show that afferent activity
from the whiskers on a rat's face trigger rapid and prolonged excitation of
the motor neurons that drive movements of the same whiskers. Positive
feedback through this sensorimotor loop may serve to optimize the interaction
between sensors and stimuli.
Comment:This study
demonstrates that there exists a sensori-motor loop that may be responsible
for changes in muscle strength after tactile stimulation. This paper shows a
small part of the potentiality of the AK technique called Therapy
Localization or TL. The cutaneomuscular reflexes have been extensively
investigated in the scientific literature, and they may be a part of the
mechanism for what is found clinically with TL testing.
|
|
Evidence for strong synaptic coupling between single
tactile afferents from the sole of the foot and motoneurons supplying leg
muscles, Fallon JB Bent
LR, McNulty PA, Macefield VG.
|
J Neurophysiol. 2005 Dec;94(6):3795-804.
Epub 2005 Aug 3.
Abstract: It has been
known for some time that populations of cutaneous and muscle afferents can
provide short-latency facilitation of motoneuron pools. Recently, it has been
shown that the input from individual low-threshold mechanoreceptors in the
glabrous skin of the hand can modulate ongoing activity in muscles acting on
the fingers via spinally mediated pathways. We have extended this work to
examine whether such strong synaptic coupling exists between tactile
afferents in the sole of the foot and motoneurons supplying muscles that act
about the ankle. We recorded from 53 low-threshold mechanoreceptors in the
glabrous skin of the foot via microelectrodes inserted percutaneously into
the tibial nerve of awake human subjects. Reflex modulation of ongoing whole
muscle electromyography (EMG) was observed for each of the four classes of
low-threshold cutaneous mechanoreceptors (17 of 21 rapidly adapting type I; 2
of 4 rapidly adapting type II; 7 of 18 slowly adapting type I; and 4 of 10
slowly adapting type II). Reflex modulation of the firing probability in
single motor units (5 of 11) was also observed. These results indicate that
strong synaptic coupling between tactile afferents and spinal motoneurons is
not a specialization of the hand and emphasizes the potential importance of
cutaneous inputs from the sole of the foot in the control of gait and
posture.
Comment:This study
demonstrates that stimulation of the skin may be responsible for changes in
muscle strength. This paper shows a small part of the potentiality of the AK
technique called Therapy Localization or TL. The cutaneomuscular reflexes
have been extensively investigated in the scientific literature, and they may
be a part of the mechanism for what is found clinically with TL testing.
|
|
Measurement of electrical skin impedance of
dermal-visceral zones as a diagnostic tool for inner organ pathologies: a
blinded preliminary evaluation of a new technique, Zimlichman E, Lahad A, Aron-Maor A,
Kanevsky A, Shoenfeld Y.
|
Isr Med
Assoc J. 2005 Oct;7(10):631-4.
BACKGROUND: As
complementary and alternative medicine is gaining popularity among health
consumers, diagnostic screening tools based on neuroreflexology are also
being developed. These techniques, which are based on the rationale that
measurement of electrical impedance of specific dermatomes reflects
corresponding internal organ pathologies, have not yet been the subject of
conventional scientific research. OBJECTIVES:
To determine the effectiveness of a neuroreflexology-based screening test,
specifically the Medex device (Medex Screen Ltd.), for diagnosing patients
undergoing conventional internal organ assessment, in a hospital setting. METHODS: Patients admitted to an internal
medicine department, who met the inclusion criteria and agreed to
participate, underwent conventional medical evaluation that included past
medical history and physical examination. Another examination was conducted
by a second physician using the Medex device to determine internal organ
pathologies. A third researcher compared the actual "conventional"
diagnosis with the Medex device output using standard statistical analysis. RESULTS: Overall, 150 patients
participated in the study. Correlation was significant for all categories (P
< 0.01) except for blood and lymphatic disease. A high sensitivity
(>70%) was measured for cardiovascular, respiratory, gastrointestinal and
genitourinary diseases. The highest measure of agreement, as represented by
the Cohen-Kappa factor, was found for respiratory disease (0.57). CONCLUSIONS: Although the exact mechanism
is not entirely clear, measurement of electroskin impedance of
dermal-visceral zones has the potential to serve as a screening tool for
inner organ pathologies. Further research should be conducted to create more
evidence to support or dispute the use of this technique as a reliable
diagnostic tool.
Comment:This study
demonstrates that the electrodermal reflexes of the skin may be reflective of
internal organ pathologies. The cutaneomuscular reflexes have been
extensively investigated in the scientific literature, and new research is
now showing that electro-dermal impedance measurements of the skin may serve
as a screening tool for inner organ pathologies. The significance of these
findings to the AK concepts of therapy localization may be evident to the
reader.
|
|
Neck flexor muscle fatigue
is side specific in patients with unilateral neck pain, Falla D, Jull
G, Rainoldi A, Merletti R.
|
Eur J Pain. 2004
Feb;8(1):71-7.
Abstract: Despite the evidence of greater fatigability of the
cervical flexor muscles in neck pain patients, the effect of
unilaterality of neck pain on muscle fatigue has not been investigated. This
study compared myoelectric manifestations of sternocleidomastoid (SCM) and
anterior scalene (AS) muscle fatigue between the painful and non-painful
sides in patients with chronic unilateral neck pain. Myoelectric signals were
recorded from the sternal head of SCM and the AS muscles bilaterally during sub-maximal
isometric cervical flexion contractions at 25% and 50% of the maximum
voluntary contraction (MVC). The time course of the mean power frequency,
average rectified value and conduction velocity of the electromyographic
signals were calculated to quantify myoelectric manifestations of muscle
fatigue. Results revealed greater estimates of the initial value and slope of
the mean frequency for both the SCM and AS muscles on the side of the
patient's neck pain at 25% and 50% of MVC. These
results indicate greater myoelectric manifestations of muscle fatigue of the
superficial cervical flexor muscles ipsilateral to the side of pain.
This suggests a specificity of the effect
of pain on muscle function and hence the need for specificity of
therapeutic exercise in the management of neck pain patients.
|
|
Impairment in the cervical flexors: a comparison of
whiplash and insidious onset neck pain patients, Jull G,
Kristjansson E, Dall'Alba
P.
|
Man
Ther. 2004 May;9(2):89-94.
Abstract:
There has been little investigation into whether or not differences
exist in the nature of physical impairment associated with neck pain of
whiplash and insidious origin. This study examined the neck flexor synergy
during performance of the cranio-cervical flexion test, a test targeting the
action of the deep neck flexors. Seventy-five volunteer subjects participated
in this study and were equally divided between Group 1, asymptomatic control
subjects, Group 2, subjects with insidious onset neck pain and Group 3,
subjects with neck pain following a whiplash injury. The cranio-cervical
flexion test was performed in five progressive stages of increasing
cranio-cervical flexion range. Subjects' performance was guided by feedback
from a pressure sensor inserted behind the neck which monitored the slight
flattening of the cervical lordosis which occurs with the contraction of
longus colli. Myoelectric signals (EMG) were detected from the muscles during
performance of the test. The results
indicated that both the insidious onset neck pain and whiplash groups had
higher measures of EMG signal amplitude (normalized root mean square) in the
sternocleidomastoid during each stage of the test compared to the control
subjects (all P<0.05) and had significantly greater shortfalls from the
pressure targets in the test stages (P<0.05). No significant
differences were evident between the neck pain groups in either parameter
indicating that this physical impairment in the neck flexor synergy is common
to neck pain of both whiplash and insidious origin.
|
|
Chronic back pain is
associated with decreased prefrontal and thalamic gray matter density, Apkarian
AV, Sosa Y, Sonty S, Levy RM, Harden RN, Parrish TB, Gitelman DR
|
J Neurosci. 2004
Nov 17;24(46):10410-5.
Abstract: The role of the
brain in chronic pain conditions remains speculative. We compared brain
morphology of 26 chronic back pain (CBP) patients to matched control
subjects, using magnetic resonance imaging brain scan data and automated
analysis techniques. CBP patients were divided into neuropathic, exhibiting
pain because of sciatic nerve damage, and non-neuropathic groups.
Pain-related characteristics were correlated to morphometric measures.
Neocortical gray matter volume was compared after skull normalization.
Patients with CBP showed 5-11% less neocortical gray matter volume than
control subjects. The magnitude of this decrease is equivalent to the gray
matter volume lost in 10-20 years of normal aging. The decreased volume was
related to pain duration, indicating a 1.3 cm3 loss of gray matter for every
year of chronic pain. Regional gray matter density in 17 CBP patients was
compared with matched controls using voxel-based morphometry and
nonparametric statistics. Gray matter density was reduced in bilateral
dorsolateral prefrontal cortex and right thalamus and was strongly related to
pain characteristics in a pattern distinct for neuropathic and
non-neuropathic CBP. Our results imply that CBP is accompanied by brain
atrophy and suggest that the pathophysiology of chronic pain includes
thalamocortical processes.
Comment: The relationship
between spinal malfunction and cerebral malfunction, specifically greatly
accelerated atrophy of the brain, is an important concept for the
chiropractic profession. This is especially important in light of the
research articles that document that chiropractic spinal adjustments are more
effective in treating chronic spinal pain when compared to medication,
exercise, and needle acupuncture.
|
|
Hypothyroidism:
A New Model for Conservative Management in Two Cases, Bablis, P. and Pollard,
H.
|
Chiro J Aust, 2004;34:11-18
Objective:To
review the function, anatomy, physiology, development, hormone synthesis and
dysfunction of the thyroid gland. Treatment options are discussed, and 2 case
studies of a mind-body therapy (Neuro-Emotional Technique—NET) successfully
managing hypothyroid dysfunction are presented. Data Sources: MEDLINE search using key words: thyroid,
synthesis, development, anatomy, physiology, hyperthyroidism and
hypothyroidism. Data Selection:
Eighty-five papers fit the key words and were selected based on relevance to
the topic. Papers were selected that contained relevant information on normal
andabnormal thyroid function
and its management. Data Extraction:
Selected papers had to contain information that directly related to the
diagnosis, anatomy, physiology and management of hypothyroid conditions.
Papers were also selected that described a possible neurophysiological
mechanism for the observed treatment effects. Data Synthesis:Objective
measures of a new mind-body approach to hypothyroid dysfunction are
presented, and its relevance to the biopsychosocial model is discussed. This
new treatment is compared to the existing biomedical approaches to treatment.
Conclusion: Thyroid dysfunction
has been effectively treated with medicine for many years. This paper
presents a new therapy that produced objective pre-post changes to
hypothyroid dysfunction in 2 cases. This therapy may have potential in future
circumstances, with further research recommended to confirm its reliability/validity.
|
|
Reliability of hand-held dynamometry in
assessment of knee extensor strength after hip fracture, Roy, MA, Doherty,
TJ.
-- School of Kinesiology, University of
Western Ontario, London, Ontario, Canada.
|
Am J Phys Med Rehabil. 2004 Nov;83(11):813-8.
OBJECTIVES:To examine the reliability of hand-held
dynamometry in assessing knee extensor strength in inpatients undergoing
rehabilitation after hip fracture and to examine the discriminant validity of
this measure. DESIGN: A total of 16 subjects (14 women;
mean +/- SD, 79 +/- 7 yrs) undergoing inpatient rehabilitation after hip
fracture volunteered to participate. Isometric knee extensor strength of the
fractured and unfractured sides was determined with a hand-held dynamometer.
Subjects were retested 1-2 days after the initial testing session. RESULTS:
Test-retest intraclass correlation coefficients were high for both
the fractured (0.91) and unfractured legs (0.90). A low coefficient of
variation was observed for both the fractured (15.3%) and unfractured (14.7%)
sides. The maximal knee extensor strength was significantly different when
comparing the fractured (7.9 +/- 3 kg) and unfractured (15.6 +/- 4 kg) legs.
When comparing test 1 and test 2 mean values for the fractured leg, the
scores significantly differed (t = 3.14, P < 0.01), with 13 of 16 subjects
scoring higher on test 2. CONCLUSIONS: Hand-held dynamometry is a
reliable and valid tool for assessment of knee extensor strength after hip
fracture. Reduced knee extensor strength in the fractured leg may be an
important component limiting rehabilitation progress in these patients.
|
|
Differences in motor recruitment and resulting kinematics between low
back pain patients and asymptomatic participants during lifting exertions, Ferguson SA, Marras WS, Burr DL, Davis KG, Gupta P.
|
Clin Biomech (Bristol, Avon). 2004
Dec;19(10):992-9.
BACKGROUND: Low back
disorders are a prevalent problem in society today and may lead to chronic
debilitating low back pain. Developing our understanding of temporal muscle
and kinematic patterns during manual material handling tasks may provide
insight for preventing the cascading series of events leading to chronic low
back pain. METHODS: Sixty-two
low back pain patients and 61 asymptomatic participants performed a variety
of lifting exertions that varied in lift origin horizontal and vertical
distance, lift asymmetry, and weight. Electromyographic activity of 10 trunk
muscles as well as trunk and pelvic kinematics was recorded during each
exertion. Differences in muscle activation and kinematic parameters were
compared between low back pain patients and asymptomatic participants as a
function of experimental conditions. FINDINGS:
Both the left and right erector spinae activated significantly earlier and
were on significantly longer in low back pain patients compared to
asymptomatic participants. The horizontal and vertical location of the lift
influenced the EMG and kinematic differences between the low back pain
patients and asymptomatic participants. INTERPRETATION:
These finding indicate that low back pain patients would be exposed to
increase muscle activity resulting in higher spine loads for a greater length
of time compared to asymptomatic participants. The longer exposure time to
increased spine load may lead to greater risk of future low back injury and
cascading events leading to debilitating low back pain. The longer muscle
activation time suggests that low back pain patients have changed their motor
program from an open to a closed loop system.
|
|
Changes in recruitment of the abdominal muscles in people with low
back pain: ultrasound measurement of muscle activity,
Ferreira PH, Ferreira ML, Hodges PW.
|
Spine. 2004 Nov
15;29(22):2560-6.
STUDY
DESIGN: Ultrasound and electromyographic (EMG) measures
of trunk muscle activity were compared between low back pain (LBP) and
control subjects in a cross-sectional study. OBJECTIVES: To compare the recruitment of the abdominal
muscles (measured as a change in thickness with ultrasound imaging) between
people with and without low back pain and to compare these measurements with
EMG recordings made with intramuscular electrodes. SUMMARY OF BACKGROUND DATA: Although ultrasonography has
been advocated as a noninvasive measure of abdominal muscle activity, it is
not known whether it can provide a valid measure of changes in motor control
of the abdominal muscles in LBP. METHODS:
Ten subjects with recurrent LBP and 10 matched controls were tested during
isometric low load tasks with their limbs suspended. Changes in thickness
from resting baseline values were obtained for transversus abdominis (TrA),
obliquus internus (OI), and obliquus externus (OE) using ultrasonography.
Fine wire EMG was measured concurrently. RESULTS:
Study participants with LBP had a significantly smaller increase in TrA
thickness with isometric leg tasks compared with controls. No difference was
found between groups for OI or OE. Similar results were found for EMG. People
with LBP had less TrA EMG activity with leg tasks, and there was no
difference between groups for EMG activity for OI or OE. CONCLUSIONS: This study reinforces
evidence for changes in automatic control of TrA in people with LBP.
Furthermore, the data establish a new test of recruitment of the abdominal
muscles in people with LBP. This test presents a feasible noninvasive test of
automatic recruitment of the abdominal muscles.
Comment: Manual muscle
testing is an obvious, feasible, and noninvasive test for the adequate
recruitment of the abdominal muscles in patients with low back pain. The inhibition
of the abdominal muscles in patients with low back pain is a consistent
finding in AK therapeutics.
|
|
Delayed onset of transversus abdominus in long-standing groin pain, Cowan SM, Schache AG, Brukner P, Bennell KL, Hodges PW, Coburn P,
Crossley KM.
|
Med Sci Sports Exerc. 2004
Dec;36(12):2040-5.
Abstract:
Long-standing groin pain is a persistent problem that is commonly
difficult to rehabilitate. Theoretical
rationale indicates a relationship between the motor control of the pelvis
and long-standing groin pain; however, this link has not been investigated.
PURPOSE: The current experiment
aimed to evaluate motor control of the abdominal muscles in a group of
Australian football players with and without long-standing groin pain. METHODS: Ten participants with
long-standing groin pain and 12 asymptomatic controls were recruited for the
study. Participants were elite or subelite Australian football players.
Fine-wire and surface electromyography electrodes were used to record the
activity of the selected abdominal and leg muscles during a visual choice
reaction-time task (active straight leg raising). RESULTS: When the asymptomatic controls completed the active
straight leg raise (ASLR) task, the transversus abdominus contracted in a
feed-forward manner. However, when individuals with long-standing groin pain
completed the ASLR task, the onset of transversus abdominus was delayed (P
< 0.05) compared with the control group. There were no differences between
groups for the onset of activity of internal oblique, external oblique, and
rectus abdominus (all P > 0.05). CONCLUSIONS:
The finding that the onset of transversus abdominus is delayed in individuals
with long-standing groin pain is important, as it demonstrates an association
between long-standing groin pain and transversus abdominus activation.
|
|
Changes in the cross-sectional area of multifidus
and psoas in patients with unilateral back pain: the relationship to pain and
disability, Barker KL,
Shamley DR, Jackson D.
|
Spine. 2004 Nov 15;29(22):E515-9.
STUDY DESIGN: Prospective,
cross-sectional observational study. OBJECTIVES:
The aim of this study was to determine if there was an association between
wasting of psoas and multifidus as observed on MRI scans and the presenting
symptoms, reported pathology, pain, or disability of a cohort of patients
presenting with unilateral low back pain. SUMMARY
OF BACKGROUND DATA: Current physiotherapy practice is often based
on localized spine stabilizing muscle exercises; most attention has been
focused on transversus abdominus and multifidus with relatively little on
psoas. METHOD: Fifty consecutive
patients presenting to a back pain triage clinic with unilateral low back
pain lasting more than 12 weeks were recruited. The cross-sectional surface
area (CSA) of the muscles was measured. Duration of symptoms, rating of pain,
self-reported function, and the presence of neural compression were recorded.
RESULTS: Data analysis compared
the CSA between the symptomatic and asymptomatic sides. There was a
statistically significant difference in CSA between the sides (P < 0.001).
There was a positive correlation between the percentage decrease in CSA of
psoas on the affected side and with the rating of pain (rho = 0.608, P <
0.01), reported nerve root compression (rho = 0.812, P < 0.01), and the
duration of symptoms (rho = 0.886, P < 0.01). There was an association
between decrease in the CSA of multifidus and duration of symptoms. CONCLUSIONS: Atrophy of multifidus has
been used as one of the rationales for spine stabilization exercises. The
evidence of coexisting atrophy of psoas and multifidus suggests that a future
area for study should be selective exercise training of psoas, which is less
commonly used in clinical practice.
Comment: Psoas muscle
dysfunction has been suggested as a major contributor to many cases of low
back pain. Successful treatment of the psoas muscle dysfunction is critical
to the resolution of low back pain in these cases.
|
|
The
efficiency of spinal manipulation in otorhinolaryngology. A retrospective
long-term study, Hulse M, Holzl M.
|
HNO. 2004
Mar;52(3):227-34.
BACKGROUND: The
vertebral genesis of many functional disorders in otorhinolaryngology, such
as dizziness, hearing-impairment, ear-pressure, ear-pain, foreign body
sensation in the throat and dysphonia, is suggested by the success of spinal
manipulative therapy, particularly of the atlanto-occipital joint. Up to now,
there are no retrospective investigations which show the duration of the
therapeutic effect. METHODS: We
examined 220 patients with cervical otorhinolaryngological disorders (100
patients with dizziness, 49 with hearing impairment, 47 with tinnitus and 24
with dysphonia) after cervical manipulation lasting more than 6 months. RESULTS AND CONCLUSIONS: The
extraordinary satisfaction with the manipulative therapy in 82% of patients
with dizziness (46% total relief, 36% high improvement) reflects the high
efficiency of this manual therapy. In contrast to these results, only 10% of
patients with tinnitus showed an improvement (P<0.001). This retrospective investigation demonstrates that a
successful outcome after manual therapy is not based on a "placebo
effect".
|
|
An exploratory study of
provocation testing with padded wedges: can prone blocking demonstrate a
directional preference? Lisi AJ, Cooperstein R, Morschhauser E.
|
J
Manipulative Physiol Ther. 2004 Feb;27(2):103-8
BACKGROUND: Currently,
no traditional chiropractic examination method to determine a spinal listing
offers demonstrated guidance in treatment decisions for low back pain (LBP)
patients. Development of an examination that bypasses the difficulty of
accurately and reliably identifying a listing, yet provides guidance on
manipulative vectors, could be very valuable to clinicians and patients. OBJECTIVE: To explore 2 potential
protocols for provocation testing and assessment of directional preference
using padded wedges. METHODS:
Two groups of 20 subjects were examined while lying prone on various
positions of padded wedges. In the first group, pain pressure threshold (PPT)
was measured at 4 anatomic points; in the second group, tenderness was
measured at 1 anatomic point. We investigated whether either method could
demonstrate a directional preference response. RESULTS: When tenderness was measured at 1 anatomic point,
70% of subjects demonstrated a directional response, and only 1 subject
exhibited an increase in baseline tenderness at the end of the procedure.
When PPT was measured at 4 anatomic points, 40% of subjects demonstrated a
directional response, but 12 subjects exhibited decreased PPT at the end of
the procedure. CONCLUSION:
Measuring changes in tenderness at 1 anatomic point in response to various
padded wedge patterns appears promising as an examination procedure to
determine directional preference.
Comment: The category
system of analysis was developed by DeJarnette and expanded by Goodheart.
This system organizes patterns of various possible bodily distortions,
particularly the disturbances that occur in the sacroiliac and lumbosacral
regions. Briefly, Category I relates
to imbalance or torque at the anterior aspect of the sacroiliac junction and
its affect on meningeal balance and CSF fluctuation. Category II is associated with various
degrees of posterior sacroiliac joint ligamentous sprain and trauma. A Category III condition will occur when
the pelvis can no longer maintain weight-bearing capacity and shifts the
"burden" to the lumbosacral junction with resultant discopathy and
radiculopathy. These pelvic distortions produce reciprocal distortions
throughout the body, especially in the pectoral girdle and first rib heads,
the TMJ, the cervical spine, and the skull. Many muscle groups will be
involved in the compensations a body makes to these pelvic category
distortions.
|
|
A comparison of muscle strength testing techniques in
amyotrophic lateral sclerosis,
Great Lakes ALS Study
Group.
|
Neurology. 2003 Dec 9;61(11):1503-7.
OBJECTIVE: To assess the reliability of strength testing
techniques among centers investigating patients with amyotrophic lateral
sclerosis. METHODS:
The authors compared test reliability in manual muscle testing (MMT) and
maximal voluntary isometric contraction (MVIC) scores among institutions and
test validity by comparing change over time between MMT and MVIC. The authors
examined 63 subjects at 3-month intervals for 12 months. At enrollment and at
6 months, two physical therapists each examined the subjects twice. MMT
scores were calculated as modifications of the Medical Research Council
scale. MVIC scores were generated as standardized megascores. Intraclass
correlation coefficients and coefficients of variation compared
reproducibility, and Pearson correlation coefficients compared change over
time. The power of each measure to detect disease progression over time was
assessed by estimating coefficients of variation for the average change. RESULTS: Reproducibility between MVIC and MMT was equivalent. Sensitivity to
detect progressive weakness and power to detect this change, however, favored
MMT, an effect largely accounted for by the number of muscles sampled.
CONCLUSIONS: In multicentered trials, uniformly trained physical therapists reproducibly and accurately
measure strength by both MMT and MVIC. The authors found MMT to be the
preferred measure of global strength because of its better Pearson correlation
coefficients, essentially equivalent reproducibility, and more favorable
coefficient of variation.
Comment: This paper is
very important in understanding the clinical value (validity) of MMT in
patients with neurologic disorders. It demonstrates that MMT is a more
sensitive, more reliable and valid measure of dysfunction in patients with
ALS than MVIC, which is another common method of muscle function evaluation.
|
|
Development of motor
system dysfunction following whiplash injury, Sterling M, Jull G, Vicenzino
B, Kenardy J, Darnell R.
|
Pain. 2003 May;103(1-2):65-73.
Abstract: Dysfunction in the motor system is a feature of
persistent whiplash associated disorders. Little is known about
motor dysfunction in the early stages following injury and of its progress in
those persons who recover and those who develop persistent symptoms. This
study measured prospectively, motor system function (cervical range of
movement (ROM), joint position error (JPE) and activity of the superficial
neck flexors (EMG) during a test of cranio-cervical flexion) as well as a
measure of fear of re-injury (TAMPA) in 66 whiplash subjects within 1 month
of injury and then 2 and 3 months post injury. Subjects were classified at 3
months post injury using scores on the neck disability index: recovered
(<8), mild pain and disability (10-28) or moderate/severe pain and
disability (>30). Motor system function was also measured in 20 control
subjects. All whiplash groups demonstrated decreased ROM and increased EMG
(compared to controls) at 1 month post injury. This deficit persisted in the group with moderate/severe symptoms but
returned to within normal limits in those who had recovered or reported
persistent mild pain at 3 months. Increased EMG persisted for 3
months in all whiplash groups. Only the moderate/severe group showed greater
JPE, within 1 month of injury, which remained unchanged at 3 months. TAMPA
scores of the moderate/severe group were higher than those of the other two
groups. The differences in TAMPA did not impact on ROM, EMG or JPE. This study identifies, for the first time, deficits
in the motor system, as early as 1 month post whiplash injury, that persisted
not only in those reporting moderate/severe symptoms at 3 months but also in
subjects who recovered and those with persistent mild symptoms.
Comment: Patients who
have experienced cervical trauma from whiplash dynamics often have perplexing
symptoms. The standard orthopedic and neurologic examination often does not
find a cause for the bizarre symptoms about which some patients complain.
Manual muscle testing is a method for evaluating the function of the nervous
system; it often reveals the cause, giving an understanding of the patient's
many complaints.Failure to
recognize problems in the motor system in whiplash patients, and failure to
correct it is often the reason a patient is labeled as being a malingerer or
having a psychoneurotic overlay to his condition, and is one of the reasons
why symptoms from whiplash injuries can persist for many years.
|
|
Neck muscle
fatigue affects postural control in man, Schieppati M, Nardone A, and Schmid
M.
|
Neuroscience, 2003;121(2):277-285.
Abstract: We
hypothesized that, since anomalous neck proprioceptive input can produce
perturbing effects on posture, neck muscle fatigue could alter body balance
control through a mechanism connected to fatigue-induced afferent inflow.
Eighteen normal subjects underwent fatiguing contractions of head extensor
muscles. Sway during quiet stance was recorded by a dynamometric platform,
both prior to and after fatigue and recovery, with eyes open and eyes closed.
After each trial, subjects were asked to rate their postural control. Fatigue
was induced by having subjects stand upright and exert a force corresponding
to about 35% of maximal voluntary effort against a device exerting a
head-flexor torque. The first fatiguing period lasted 5 min (F1). After a
5-min recovery period (R1), a second period of fatiguing contraction (F2) and
a second period of recovery (R2) followed. Surface EMG activity from dorsal
neck muscles was recorded during the contractions and quiet stance trials.
EMG median frequency progressively decreased and EMG amplitude progressively
increased during fatiguing contractions, demonstrating that muscle fatigue
occurred. After F1, subjects swayed to a larger extent compared with control
conditions, recovering after R1. Similar findings were obtained after F2 and
after R2. Although such behavior was detectable under both visual conditions,
the effects of fatigue reached significance only without vision. Subjective
scores of postural control diminished when sway increased, but diminished
more, for equal body sway, after fatigue and recovery. Contractions of the
same duration, but not inducing EMG signs of fatigue, had much less influence
on body sway or subjective scoring. We argue that neck muscle fatigue affects
mechanisms of postural control by producing abnormal sensory input to the CNS
and a lasting sense of instability. Vision is able to overcome the disturbing
effects connected with neck muscle fatigue.
|
|
Myoelectric manifestations of sternocleidomastoid and anterior
scalene muscle fatigue in chronic neck pain patients, Falla D, Rainoldi A, Merletti R, Jull G.
|
Clin Neurophysiol. 2003
Mar;114(3):488-95.
OBJECTIVE: This study
compares myoelectric manifestations of fatigue of the sternocleidomastoid
(SCM) and anterior scalene (AS) muscles between 10 chronic neck pain subjects
and 10 normal matched controls. METHODS:
Surface electromyography (sEMG) signals were recorded from the sternal head
of SCM and AS muscles bilaterally during sub-maximal isometric cervical
flexion contractions at 25 and 50% of the maximum voluntary contraction
(MVC). The mean frequency, average rectified value and conduction velocity of
the sEMG signal were calculated to quantify myoelectric manifestations of
muscle fatigue. RESULTS: For
both the SCM and AS muscles, the Mann-Whitney U test indicated that the
initial value and slope of the mean frequency in neck pain patients were
greater than in healthy subjects (P < 0.05). This was significant both at
25 and 50% of MVC. CONCLUSIONS:
These results suggest: (a) a predominance of type-II fibres in the neck pain
patients and/or (b) greater fatigability of the superficial cervical flexors
in neck pain patients. These results are in agreement with previous muscle
biopsy studies in subjects with neck pain, which identified transformation of
slow-twitch type-1 fibres to fast-twitch type-IIB fibres, as well as the
clinical observation of reduced endurance in the cervical flexors in neck
pain patients.
|
|
Association of widespread body pain with an
increased risk of cancer and reduced cancer survival: a prospective,
population-based study, McBeth J, Silman AJ, Macfarlane GJ
|
Arthritis Rheum. 2003
Jun;48(6):1686-92.
OBJECTIVE: To determine
whether reported widespread body pain is related to an increased incidence of
cancer and/or reduced survival from cancer, since our previous population
surveys have demonstrated a relationship between widespread body pain and a
subsequent 2-fold increase in mortality from cancer over an 8-year period. METHODS: A total of 6565 subjects in
Northwest England participated in 2 health surveys during 1991-1992. The
subjects were classified according to their reported pain status (no pain,
regional pain, and widespread pain), and were subsequently followed up
prospectively until December 31, 1999. During follow up, information was
collected on incidence of cancer and survival rates among those developing
cancer. Associations between the original pain status and development of
cancer and cancer survival were expressed as the incidence rate ratio (IRR)
and mortality rate ratio (MRR), respectively. All analyses were adjusted for
age, sex, and study location, the latter being a proxy measure of
socioeconomic status. RESULTS:
Among the study population, 6331 had never been diagnosed with cancer at the
time of participation in the survey. Of these subjects, 956 (15%) were
classified as having widespread pain, 3061 (48%) as having regional pain, and
2314 (37%) as having no pain. There were a total of 395 first malignancies
recorded during follow up. In comparison with subjects reporting no pain,
those with regional pain (IRR 1.19, 95% confidence interval [95% CI]
0.94-1.50) and widespread pain (IRR 1.61, 95% CI 1.21-2.13) experienced an
excess incidence of cancer during the follow up period. The increased
incidence among subjects previously reporting widespread pain was related,
most strongly, to breast cancer (IRR 3.67, 95% CI 1.39-9.68), but there were
also cancers of the prostate (IRR 3.46, 95% CI 1.25-9.59), large bowel (IRR
2.35, 95% CI 0.96-5.77), and lung (IRR 2.04, 95% CI 0.96-4.34). Subjects
reporting widespread pain who subsequently developed cancer, in comparison
with those previously reporting no pain, had an increased risk of death (MRR
1.82, 95% CI 1.18-2.80). This decreased survival was highest among subjects
with cancers of the breast and prostate, although the effects on
site-specific survival were nonsignificant. CONCLUSION:
This study has demonstrated that widespread pain reported in
population surveys is associated with a substantial subsequent increased
incidence of cancer and reduced cancer survival. At present there are no
satisfactory biologic explanations for this observation, although several possible
leads have been identified.
Comment: The importance
of this study is that patients with spinal injuries that lead to aberrant
afferent mechanical input into the spinal cord, ultimately resulting in
chronic back pain, may face a statistically significant increase in death
rates from cancer.
|
|
The use of osteopathic
manipulative treatment as adjuvant therapy in children with recurrent acute
otitis media, Mills MV, Henley CE, Barnes LL, Carreiro JE, Degenhardt
BF.
|
Arch Pediatr Adolesc Med. 2003
Sep;157(9):861-6.
OBJECTIVE: To study
effects of osteopathic manipulative treatment as an adjuvant therapy to
routine pediatric care in children with recurrent acute otitis media (AOM). STUDY DESIGN: Patients 6 months to 6
years old with 3 episodes of AOM in the previous 6 months, or 4 in the
previous year, who were not already surgical candidates were placed randomly
into 2 groups: one receiving routine pediatric care, the other receiving
routine care plus osteopathic manipulative treatment. Both groups received an
equal number of study encounters to monitor behavior and obtain tympanograms.
Clinical status was monitored with review of pediatric records. The
pediatrician was blinded to patient group and study outcomes, and the
osteopathic physician was blinded to patient clinical course. MAIN OUTCOME MEASURES: We monitored
frequency of episodes of AOM, antibiotic use, surgical interventions, various
behaviors, and tympanometric and audiometric performance. RESULTS: A total of 57 patients, 25
intervention patients and 32 control patients, met criteria and completed the
study. Adjusting for the baseline frequency before study entry, intervention
patients had fewer episodes of AOM (mean group difference per month, -0.14
[95% confidence interval, -0.27 to 0.00]; P =.04), fewer surgical procedures
(intervention patients, 1; control patients, 8; P =.03), and more mean
surgery-free months (intervention patients, 6.00; control patients, 5.25; P
=.01). Baseline and final tympanograms obtained by the audiologist showed an
increased frequency of more normal tympanogram types in the intervention
group, with an adjusted mean group difference of 0.55 (95% confidence
interval, 0.08 to 1.02; P =.02). No adverse reactions were reported. CONCLUSIONS: The results of this study
suggest a potential benefit of osteopathic manipulative treatment as adjuvant
therapy in children with recurrent AOM; it may prevent or decrease surgical
intervention or antibiotic overuse.
|
|
Presence of Chapman reflex
points in hospitalized patients with pneumonia,
Washington K, Mosiello R, Venditto M, Simelaro J, Coughlin P, Crow WT,
Nicholas A.
|
J Am Osteopath Assoc. 2003
Oct;103(10):479-83.
Abstract: The authors
undertook a case control study to determine whether hospitalized patients
with pneumonia had reflex points in the anterior chest wall as described by
Frank Chapman, DO, specifically those classified as relating to the lung.
Sixty-nine hospitalized patients were enrolled in the study. Patients with an
admitting diagnosis of pneumonia were compared to those without pneumonia as
their admitting diagnosis. All patients were examined to determine if Chapman
reflex points for the lungs were present. The study controlled for potential
confounding diagnoses by excluding patients with lung pathology other than
pneumonia. Results demonstrated a statistically significant relationship
between the presence of Chapman reflex points and pneumonia in hospitalized
patients.
|
|
Reliability of 4 outcome measures in pediatric
spinal muscular atrophy, Iannaccone
ST, Hynan LS, American Spinal Muscular Atrophy Randomized Trials (AmSMART)
Group.
|
Arch
Neurol. 2003 Aug;60(8):1130-6.
BACKGROUND: Spinal
muscular atrophy is a common neurologic disorder of infants and children with
a high mortality rate. Clinical trials have not been attempted in this
population until recently. OBJECTIVE:
To demonstrate that 4 outcome measures are reliable for use in clinical
trials in patients with spinal muscular atrophy. DESIGN, SETTING, PATIENTS: Thirty-eight children with spinal
muscular atrophy who fulfilled inclusion and exclusion criteria were enrolled
at 5 pediatric centers for a reliability study. Paired samples statistics
were performed comparing results of the qualifying variance visit with a
fourth visit. MAIN OUTCOME MEASURES:
Quantitative muscle testing and the Gross
Motor Function Measure. RESULTS: Thirty-four patients and 7
evaluators completed the study. Thirteen patients were aged 2 through 4 years
and 21 were 5 through 17 years. The Gross Motor Function Measure was
completed by 34 subjects. Six variables for pulmonary function tests were
measured in 20 subjects. Quantitative muscle testing was performed on 21
subjects in 8 muscle groups. Thirty-three subjects completed the PedsQL
Neuromuscular Module for Parents. The
intraclass correlation coefficient and Bradley-Blackwood procedures indicated
a very high level of agreement between measures. CONCLUSION: The Gross Motor Function Measure, pulmonary function tests,
quantitative muscle testing, and quality of life are reliable outcome
measures for clinical trials in pediatric spinal muscular atrophy.
|
|
Pain and motor control of
the lumbopelvic region: effect and possible mechanisms, Hodges PW,
Moseley GL.
|
J Electromyogr Kinesiol. 2003
Aug;13(4):361-70.
Abstract: Many authors
report changes in the control of the trunk muscles in people with low back
pain (LBP). Although there is considerable disagreement regarding the nature
of these changes, we have consistently found differential effects on the deep
intrinsic and superficial muscles of the lumbopelvic region. Two issues
require consideration; first, the potential mechanisms for these changes in
control, and secondly, the effect or outcome of changes in control for
lumbopelvic function. Recent data indicate that experimentally induced pain
may replicate some of the changes identified in people with LBP. While this
does not exclude the possibility that changes in control of the trunk muscles
may lead to pain, it does argue that, at least in some cases, pain may cause
the changes in control. There are many possible mechanisms, including changes
in excitability in the motor pathway, changes in the sensory system, and
factors associated with the attention demanding, stressful and fearful
aspects of pain. A new hypothesis is presented regarding the outcome from
differential effects of pain on the elements of the motor system. Taken
together these data argue for strategies of prevention and rehabilitation of
LBP.
Comment: In the AK
clinical setting, MMT that produces pain during the test will also demonstrate
inhibition of the muscle tested. When the proper therapy is employed, the MMT
inhibition of the muscle and the pain during the MMT of the muscle are
improved. This correlation is explored in this paper.
|
|
Evidence of altered
lumbopelvic muscle recruitment in the presence of sacroiliac joint pain, Hungerford
B, Gilleard W, Hodges P.
|
Spine. 2003 Jul
15;28(14):1593-600.
STUDY DESIGN:
Cross-sectional study of electromyographic onsets of trunk and hip muscles in
subjects with a clinical diagnosis of sacroiliac joint pain and matched
control subjects. OBJECTIVES: To
determine whether muscle activation of the supporting leg was different
between control subjects and subjects with sacroiliac joint pain during hip
flexion in standing. BACKGROUND:
Activation of the trunk and gluteal muscles stabilize the pelvis for load
transference; however, the temporal pattern of muscle activation and the
effect of pelvic pain on temporal parameters has not been investigated. METHODS: Fourteen men with a clinical
diagnosis of sacroiliac joint pain and healthy age-matched control subjects
were studied. Surface electromyographic activity was recorded from seven
trunk and hip muscles of the supporting leg during hip flexion in standing.
Onset of muscle activity relative to initiation of the task was compared
between groups and between limbs. RESULTS:
The onset of obliquus internus abdominis (OI) and multifidus occurred before
initiation of weight transfer in the control subjects. The onset of obliquus
internus abdominis, multifidus, and gluteus maximus was delayed on the
symptomatic side in subjects with sacroiliac joint pain compared with control
subjects, and the onset of biceps femoris electromyographic activity was
earlier. In addition, electromyographic onsets were different between the
symptomatic and asymptomatic sides in subjects with sacroiliac joint pain. CONCLUSIONS: The delayed onset of
obliquus internus abdominis, multifidus, and gluteus maximus
electromyographic activity of the supporting leg during hip flexion, in
subjects with sacroiliac joint pain, suggests an alteration in the strategy
for lumbopelvic stabilization that may disrupt load transference through the
pelvis.
Comment: The importance
of specific treatment of muscle imbalances related to the sacroiliac joints
is apparent from this study.
|
|
Comorbidity of internal
derangement of the temporomandibular joint and silent dysfunction of the
cervical spine, Stiesch-Scholz M, Fink M, Tschernitschek H.
|
J Oral Rehabil. 2003
Apr;30(4):386-91.
Abstract: The aim of
this evaluation was to examine correlations between internal derangement of
the temporomandibular joint (TMJ) and cervical spine disorder (CSD). A
prospective controlled clinical study was carried out. Thirty patients with
signs and symptoms of internal derangement but without any subjective neck
problems and 30 age- and gender-matched control subjects without signs and
symptoms of internal derangement were examined. The investigation of the
temporomandibular system was carried out using a 'Craniomandibular Index'. Afterwards
an examiner-blinded manual medical investigation of the craniocervical system
was performed. This included muscle palpation of the cervical spine and
shoulder girdle as well as passive movement tests of the cervical spine, to
detect restrictions in the range of movement as well as segmental
intervertebral dysfunction. The internal derangement of the TMJ was
significantly associated with 'silent' CSD (t-test, P < 0.05). Patients
with raised muscle tenderness of the temporomandibular system exhibited
significantly more often pain on pressure of the neck muscles than patients
without muscle tenderness of the temporomandibular system (t-test, P <
0.05). As a result of the present study, for patients with internal
derangement of the TMJ an additional examination of the craniocervical system
should be recommended.
Comment: In AK there
is recognition of the stomatognathic system, and of the importance of the
cervical spine to the treatment of the TMJ. The stomatognathic system
involves the complex interaction between structures and functions of the head
and neck.
|
|
The functional
relationship between the craniomandibular system, cervical spine, and the
sacroiliac joint: a preliminary investigation, Fink M, Wahling K,
Stiesch-Scholz M, Tschernitschek H.
|
Cranio. 2003 Jul;21(3):202-8.
Abstract: The hypothesis
of a functional coupling between the muscles of the craniomandibular system
and the muscles of other body areas is still controversial. The purpose of
this pilot study was to examine whether there is a relationship between the
craniomandibular system, the craniocervical system and the sacropelvic
region. To test this hypothesis, the prevalence and localization of
dysfunction of the cervical spine and the sacroiliac joint were examined in a
prospective, experimental trial. Twenty healthy students underwent an
artificial occlusal interference, which caused an occlusal interference. The
upper cervical spine (CO-C3) and the sacroiliac joint were examined before,
during and after this experimental test. The primary outcome with these
experimental conditions was the occurrence of hypomobile functional
abnormalities. In the presence of occlusal interference, functional
abnormalities were detected in both regions examined and these changes were
statistically significant. The clinical implications of these findings may be
that a complementary examination of these areas in CMD patients could be
useful.
|
|
The"iliacus test": new information for theevaluation of hip extension dysfunction,
Eland DC, Singleton TN, Conaster RR, Howell JN, Pheley AM,
Karlene MM, Robinson
JM.
|
JAOA. March 2002;102(3):130-142.
Abstract: This
study confirms the clinical value of investigating the "iliacus
complex" during evaluations of the low back. A new "iliacus
test" isolates this iliacus complex component of limited hip extension.
Designed for a single joint, the test isolates motion across the hip joint.
Study results include the following: (1) in a comparison with the clinical
standard, the Thomas test, data show that the two tests are significantly
different in an asymptomatic population between the ages of 18 and 35 years;
(2) with the exception of the standard Thomas test, the data show no
statistical differences in range of motion when comparing the left side with
the right side; (3) examiner-added, end-range pressure for assessment of
range of motion when compared with the standard gravity-dependent end range
of motion used in the Thomas test yields valuable new information; and (4)
data provide a basis for population norms for each test--Thomas and
iliacus--in gravity-dependent and examiner-produced tissue-feel end ranges.
|
|
Cervical muscle dysfunction in chronic
whiplash-associated disorder grade 2: the relevance of the trauma, Nederhand MJ, Hermens HJ, IJzerman MJ, Turk
DC, Zilvold G.
|
Spine. 2002 May
15;27(10):1056-61.
STUDY
DESIGN: Surface electromyography measurements of the
upper trapezius muscles were performed in patients with a chronic
whiplash-associated disorder Grade 2 and those with nonspecific neck pain. OBJECTIVE: To determine the etiologic
relation between acceleration-deceleration trauma and the presence of
cervical muscle dysfunction in the chronic stage of whiplash-associated
disorder. SUMMARY OF BACKGROUND
INFORMATION: From a biopsychosocial perspective, the acceleration-deceleration
trauma in patients with whiplash-associated disorder is not regarded as a
cause of chronicity of neck pain, but rather as a risk factor triggering
response systems that contribute to the maintenance of neck pain. One of the contributing factors is dysfunction of
the cervical muscles. Considering the limited etiologic
significance of the trauma, it is hypothesized that in patients with neck
pain, there are no differences in muscle activation patterns between those
with and those without a history of an acceleration-deceleration trauma. METHODS: Muscle activation patterns,
expressed in normalized smooth rectified electromyography levels of the upper
trapezius muscles, in patients with whiplash-associated disorder Grade 2 were
compared with those of patients with nonspecific neck pain. The outcome
parameters were the mean level of muscle activity before and after a physical
exercise, the muscle reactivity in response to the exercise, and the
time-dependent behavior of muscle activity after the exercise. RESULTS: There were no statistical
significant differences in any of the outcome parameters between patients
with whiplash-associated disorder Grade 2 and those with nonspecific neck
pain. There was only a tendency of higher muscle reactivity in patients with
whiplash-associated disorder Grade 2. CONCLUSIONS:
It appears that the cervical muscle dysfunction in patients with chronic
whiplash-associated disorder Grade 2 is not related to the specific trauma
mechanism. Rather, cervical muscle
dysfunction appears to be a general sign in diverse chronic neck pain
syndromes.
Comment: This is
another paper by Nederhand et al that is very important for AK. In terms of
the etiology of symptoms from chronic whiplash disorders, this study suggests
that the performance of the upper trapezius muscle is an invaluable
diagnostic measurement in the evaluation of patients with chronic neck pain
and chronic whiplash-associated disorders. The evaluation and treatment of
upper trapezius muscle dysfunction is a standard part of AK therapy.
|
|
Do cerebral potentials to
magnetic stimulation of paraspinal muscles reflect changes in palpable muscle
spasm, low back pain, and activity scores? Zhu Y, Haldeman S, Hsieh
CY, Wu P, Starr A.
|
J Manipulative Physiol Ther. 2002
Jan;25(1):77-8.
OBJECTIVE: Previous studies have shown that cortical-evoked
potentials on magnetic stimulation of muscles are influenced by muscle
contraction, vibration, and muscle spasm. This study was carried out to
determine whether these potentials correlate with palpatory muscle spasm,
patient symptoms, and disability in patients with low back pain. METHODS: A
prospective observational study was performed on 13 subjects with a history
of low back pain visiting an orthopedic hospital-based clinic. Patients were
screened for serious pathologic conditions by an orthopedic surgeon. The
patients were then evaluated for the presence of muscle spasm by one of the
investigators who was blinded to the results of the evoked potential studies.
Patients were asked to complete a low back pain visual analogue scale (VAS)
and a Roland-Morris Activity Scale (RMAS). Cortical-evoked potentials were
recorded with a magnetic stimulator placed over the lumbar paraspinal muscles
with the patient in the prone position. The palpatory examination, VAS, RMAS,
and the cortical potentials were repeated after 2 weeks of therapy commonly
used to reduce muscle spasm. RESULTS: The patients demonstrated a significant
decrease in low back pain VAS and RMAS scores after treatment compared with
before treatment. There was a reduction in the amount of palpatory muscle
spasm in 11 of 13 cases. The cortical potentials before treatment were
attenuated compared with previously reported controls and showed a
significant increase before and after treatment in the amplitude of these
potentials with multivariate analysis of variance. There was significant
correlation between the changes in cortical potentials after treatment and
the changes noted in paraspinal muscle spasm and VAS and RMAS scores.
CONCLUSIONS: This study confirms the previous report that the amplitude of
cerebral-evoked potentials on magnetic stimulation of paraspinal muscles is
depressed in the presence of palpable muscle spasm. The close correlation among these potentials,
paraspinal muscle spasm, and clinical symptoms suggests that the measurement
of muscle activity may be more important in the assessment of low back pain
than is commonly accepted.
Comment: This hypothesis
has been made in AK since the technique was founded. Through evaluation of
the function of certain muscles pre- and post-treatment, therapeutic efficacy
for particular problems can be evaluated. Applied kinesiologists theorize
that physical, chemical, and mental imbalances are associated with secondary
muscle dysfunction – specifically a muscle inhibition (usually preceding an
overfacilitation of an opposing muscle). Applying the proper therapy results
in improvement in the inhibited muscle. This study demonstrates the
simultaneous presence of muscle spasm and depressed cortical-evoked
potentials in patients with low back pain. After 2 weeks of chiropractic
spinal therapy the patients were alleviated of their clinical symptoms and
increased the synaptic efficacy of Ia afferent activation to the central
nervous system.
|
|
Exercise-induced muscle
damage in humans, Clarkson PM, Hubal MJ.
|
Am J Phys Med Rehabil. 2002
Nov;81(11 Suppl):S52-69.
Abstract:
Exercise-induced muscle injury in humans frequently occurs after unaccustomed
exercise, particularly if the exercise involves a large amount of eccentric
(muscle lengthening) contractions. Direct measures of exercise-induced muscle
damage include cellular and subcellular disturbances, particularly Z-line
streaming. Several indirectly assessed markers of muscle damage after
exercise include increases in T2 signal intensity via magnetic resonance
imaging techniques, prolonged decreases in force production measured during
both voluntary and electrically stimulated contractions (particularly at low
stimulation frequencies), increases in inflammatory markers both within the
injured muscle and in the blood, increased appearance of muscle proteins in
the blood, and muscular soreness. Although the exact mechanisms to explain
these changes have not been delineated, the initial injury is ascribed to mechanical
disruption of the fiber, and subsequent damage is linked to inflammatory
processes and to changes in excitation-contraction coupling within the
muscle. Performance of one bout of eccentric exercise induces an adaptation
such that the muscle is less vulnerable to a subsequent bout of eccentric
exercise. Although several theories have been proposed to explain this
"repeated bout effect," including altered motor unit recruitment,
an increase in sarcomeres in series, a blunted inflammatory response, and a
reduction in stress-susceptible fibers, there is no general agreement as to
its cause. In addition, there is controversy concerning the presence of sex
differences in the response of muscle to damage-inducing exercise. In
contrast to the animal literature, which clearly shows that females
experience less damage than males, research using human studies suggests that
there is either no difference between men and women or that women are more
prone to exercise-induced muscle damage than are men.
Comment: The first
technique used in AK to change muscle function was firm manipulation of the
muscle’s origin and insertion. When muscle weakness was found on MMT, small
nodules at the origin or insertion were often present in the muscle. A
history of trauma to the muscle will usually be present. Significant research on muscle soreness has focused on
eccentric muscle contractions. During this type of muscular movement, muscles
lengthen, which causes the microtears characteristic of exercise-induced
muscle damage. The AK hypothesis that in some cases muscle
weakness is due to a microavulsion of the tendon from the periosteum finds
substantiation in this study.
|
|
Neurophysiological effects
of spinal manipulation, Pickar JG.
|
Spine J. 2002 Sep-Oct;2(5):357-71.
BACKGROUND CONTEXT: Despite
clinical evidence for the benefits of spinal manipulation and the apparent
wide usage of it, the biological mechanisms underlying the effects of spinal
manipulation are not known. Although this does not negate the clinical
effects of spinal manipulation, it hinders acceptance by the wider scientific
and health-care communities and hinders rational strategies for improving the
delivery of spinal manipulation. PURPOSE:
The purpose of this review article is to examine the neurophysiological basis
for the effects of spinal manipulation. STUDY
DESIGN: A review article discussing primarily basic science
literature and clinically oriented basic science studies. METHODS: This review article draws
primarily from the peer-reviewed literature available on Medline. Several
textbook publications and reports are referenced. A theoretical model is
presented describing the relationships between spinal manipulation, segmental
biomechanics, the nervous system and end-organ physiology. Experimental data
for these relationships are presented. RESULTS:
Biomechanical changes caused by spinal manipulation are thought to have
physiological consequences by means of their effects on the inflow of sensory
information to the central nervous system. Muscle
spindle afferents and Golgi tendon organ afferents are stimulated by spinal
manipulation. Smaller-diameter sensory nerve fibers are likely
activated, although this has not been demonstrated directly. Mechanical and
chemical changes in the intervertebral foramen caused by a herniated
intervertebral disc can affect the dorsal roots and dorsal root ganglia, but
it is not known if spinal manipulation directly affects these changes.
Individuals with herniated lumbar discs have shown clinical improvement in
response to spinal manipulation. The phenomenon of central facilitation is
known to increase the receptive field of central neurons, enabling either
subthreshold or innocuous stimuli access to central pain pathways. Numerous
studies show that spinal manipulation increases pain tolerance or its
threshold. One mechanism underlying the effects of spinal manipulation may,
therefore, be the manipulation's ability to alter central sensory processing
by removing subthreshold mechanical or chemical stimuli from paraspinal
tissues. Spinal manipulation is also
thought to affect reflex neural outputs to both muscle and visceral organs.
Substantial evidence demonstrates that
spinal manipulation evokes paraspinal muscle reflexes and alters motoneuron
excitability. The effects of spinal manipulation on these
somatosomatic reflexes may be quite complex, producing excitatory and
inhibitory effects. Whereas substantial information also shows that sensory
input, especially noxious input, from paraspinal tissues can reflexively
elicit sympathetic nerve activity, knowledge about spinal manipulation's
effects on these reflexes and on end-organ function is more limited. CONCLUSIONS: A theoretical framework
exists from which hypotheses about the neurophysiological effects of spinal
manipulation can be developed. An
experimental body of evidence exists indicating that spinal manipulation
impacts primary afferent neurons from paraspinal tissues, the motor control
system and pain processing. Experimental work in this area is
warranted and should be encouraged to help better understand mechanisms
underlying the therapeutic scope of spinal manipulation.
Comment: This important
review of the current scientific literature suggests that spinal manipulation
alters group Ia and group II mechanoreceptor discharge and significantly
affects the motor control system. Central motor facilitation is a basic,
immediate neurophysiological response to chiropractic care. This paper
reviews the evidence that reductions in resting muscular tone (quantified by
surface electromyography in the prone posture) have been documented following
spinal adjustments, as have improvements in muscular strength.
|
|
Central
motor excitability changes after spinal manipulation: A transcranial magnetic
stimulation study, Dishman J, Ball K, Burke J.
|
J Manipulative Physiol Ther 2002;25:1-9
Background: The physiologic mechanism by which spinal manipulation
may reduce pain and muscular spasm is not fully understood. One such
mechanistic theory proposed is that spinal manipulation may intervene in the
cycle of pain and spasm by affecting the resting excitability of the
motoneuron pool in the spinal cord. Previous data from our laboratory
indicate that spinal manipulation leads to attenuation of the excitability of
the motor neuron pool when assessed by means of peripheral nerve Ia-afferent
stimulation (Hoffmann reflex). Objective: The purpose of
this study was to determine the effects of lumbar spinal manipulation on the
excitability of the motor neuron pool as assessed by means of transcranial
magnetic stimulation. Methods: Motor-evoked
potentials were recorded subsequent to transcranial magnetic stimulation. The
motor-evoked potential peak-to-peak amplitudes in the right gastrocnemius
muscle of healthy volunteers (n = 24) were measured before and after homolateral
L5-S1 spinal manipulation (experimental group) or side-posture positioning
with no manipulative thrust applied (control group). Immediately after the
group-specific procedure, and again at 5 and 10 minutes after the procedure,
10 motor-evoked potential responses were measured at a rate of 0.05 Hz. An
optical tracking system (OptoTRAK, Northern Digital Inc, Waterloo, Canada
[<0.10 mm root-mean-square]) was used to monitor the 3-dimensional (3-D)
position and orientation of the transcranial magnetic stimulation coil, in
real time, for each trial. Results: The amplitudes of
the motor-evoked potentials were significantly facilitated from 20 to 60
seconds relative to the pre baseline value after L5-S1 spinal manipulation,
without a concomitant change after the positioning (control) procedure. Conclusions: When motor neuron
pool excitability is measured directly by central corticospinal activation
with transcranial magnetic stimulation techniques, a transient but
significant facilitation occurs as a consequence of spinal manipulation.
Thus, a basic neurophysiologic response to spinal manipulation is central
motor facilitation.
|
|
Assessment of isokinetic muscle strength in
women who are obese, Hulens M, Vansant G, Lysens R, Claessens AL, Muls E.
-- Department of Rehabilitation Sciences,
Faculty of Physical Education and Physiotherapy, Katholieke Universiteit,
Leuven, Belgium. maria.hulens@flok.kuleuven.ac.be
|
J Orthop Sports Phys Ther. 2002 Jul;32(7):347-56.
STUDY DESIGN: Cross-sectional
study of isokinetic trunk and knee muscle strength in women who are obese. OBJECTIVE: To provide reference values,
to identify variables that affect peripheral muscle strength, and to provide
recommendations for isokinetic testing of trunk and knee muscles in women who
are obese and morbidly obese. BACKGROUND:
The assessment of peripheral muscle strength is useful for the quantification
of possible loss of strength, for exercise prescription, and for the
evaluation of the effect of training programs in obese individuals. METHODS AND MEASURES: Isokinetic trunk
and leg muscle strength was assessed in 241 women who were obese (18-65
years, body mass index (BMI) > or = 30 kg/m2). Trunk flexion and extension
peak torque (PT) was measured using the Cybex TEF dynamometer; trunk rotation
(TR) PT was measured using the Cybex TORSO dynamometer; and knee
flexion/extension (KFE) PT was measured using the Cybex 350 dynamometer. Body
composition was assessed using the bioelectrical impedance method; physical
activity was assessed using the Baecke questionnaire; and peak VO2 was
assessed using an incremental exercise capacity test on a bicycle ergometer.
To identify variables related to muscle strength, Pearson correlations were
computed and a stepwise multiple regression analysis was performed. RESULTS: Pearson correlation coefficients
of all strength measurements at 60 degrees/s revealed low-to-moderate
negative associations with age and positive associations with mass, height,
fat free mass (FFM), and peak VO2 (P < 0.05), except for gravity-uncorrected
trunk extension strength, which was not related to mass. The sports index of
the Baecke questionnaire was associated with TR PT (r = 0.20, P < 0.01)
and KFE PT (r = 0.18, P < 0.05). CONCLUSION:
The weight of the trunk accounts largely for the measured trunk extensor and
flexor strength in women who are obese. Contributing variables of isokinetic
trunk flexion and extension strength in women who are obese are age, height,
and FFM; whereas sports activities and aerobic fitness are contributing factors
for trunk rotational and knee extension strength. Recommendations for
measuring isokinetic muscle strength in individuals who are obese are
provided.
|
|
Decrease in elbow flexor inhibition after cervical spine manipulation
in patients with chronic neck pain, Suter E,
McMorland G.
|
Clin Biomech (Bristol, Avon). 2002
Aug;17(7):541-4.
OBJECTIVE: This study
measured functional capacity and subjective pain in patients with chronic
neck pain before and after manipulation of the cervical spine. DESIGN: Outcomes study on 16 patients
with chronic neck pain. BACKGROUND:
Muscle inhibition, i.e., the inability to fully activate a muscle, has been
observed following joint pathologies and in low back pain conditions.
Although chronic neck pain has been associated with changes in muscle
recruitment and coordination in the shoulder and arms, the possibility of
muscle inhibition has not been explored. METHODS:
Biceps activation during a maximal voluntary elbow flexor contraction was
assessed using the interpolated twitch technique and electromyography.
Cervical range of motion and pressure pain thresholds were measured using a
goniometer and an algometer. Manipulation of the cervical spine was applied
at the level of C5/6/7, and functional assessments were repeated. RESULTS: Patients showed significant
inhibition in their biceps muscles. Cervical range of motion was restricted
laterally, and increased pressure pain sensitivity was evident. After
cervical spine manipulation, a significant reduction in biceps inhibition and
an increase in biceps force occurred. Cervical range of motion and pressure
pain thresholds increased significantly. CONCLUSIONS:
Significant dysfunction in biceps
activation was evident in patients with chronic neck pain, indicating that
this muscle group cannot be used to the full extent. Spinal manipulation
decreased muscle inhibition and increased elbow flexor strength at least in
the short term. RELEVANCE: Muscle inhibition in the biceps has not
been previously documented in patients with chronic neck pain. Further
research is needed to establish whether muscle inhibition is related to
clinical symptoms and functional outcome. Spinal manipulation improved muscle
function, cervical range of motion and pain sensitivity, and might therefore
be beneficial for treating patients with chronic neck pain.
Comment: The
relationship between spinal dysfunction and muscular inhibition is very
clearly demonstrated in this paper.
|
|
The reliability of upper- and lower-extremity
strength testing in a community survey of older adults, Ottenbacher KJ,
Branch LG, Ray L, Gonzales VA, Peek MK, Hinman MR.
-- Division of Rehabilitation Sciences, Sealy
Center on Aging, University of Texas Medical Branch, Galveston, TX
77555-1028, USA. kottenbo@utmb.edu
|
Arch Phys Med Rehabil. 2002 Oct;83(10):1423-7.
OBJECTIVE: To examine the
stability (test-retest reliability) of strength measures in older adults
obtained by nontherapist lay examiners by using a hand-held portable muscle
testing device (Nicholas Manual Muscle Tester). DESIGN: A prospective relational design was used to collect
test-retest data for 1 male subject by using 27 lay raters who completed
intensive training in manual muscle. SETTING:
Data were collected from older Mexican-American adults living in the
community. PARTICIPANTS:
Twenty-seven lay raters who completed intensive training in manual muscle
testing for a field-based assessment and interview of older adults and 63
Mexican-American subjects completing wave 4 of the Hispanic Established
Populations for the Epidemiologic Study of the Elderly. INTERVENTIONS: Training involved
reviewing a manual describing each testing position followed by approximately
6 hours of instruction and practice supervised by an experienced physical
therapist. Lay raters then collected test-retest information on older
Mexican-American subjects. MAIN OUTCOME
MEASURE: Stability (test-retest) for a portable manual muscle
testing device. RESULTS:
Intraclass correlation coefficients (ICCs) were computed for the 27 lay
raters examining 1 male subject (2 trials) and 12 lay raters assessing 63
older Mexican-American adults (1 practice and 2 trials recorded). The ICC
values for the first 27 lay raters ranged from .74 to.96. The ICC values for
the latter 12 lay raters ranged from .87 to.98. No differences were found in
ICC values between male or female subjects. CONCLUSIONS:
Stable and consistent information for upper- and lower-extremity strength was
collected from the older adults participating in this study. The results
suggest reliable information can be obtained by lay raters using a portable
manual muscle testing device if the examiners receive intensive training.
|
|
Sensorimotor
control of the spine, Holm, S., Indahl, A., Solomonow, M.
|
Journal of Electromyography and
Kinesiology, 2002,12;3:219-234.
(http://www.isek-online.org/)
Abstract: The spinal
viscoelastic structures including disk, capsule and ligaments were reviewed
with special focus on their sensory motor functions. Afferent capable of
monitoring proprioceptive and kinesthetic information are abundant in the
disc, capsule and ligament. Electrical stimulation of the lumbar afferents in
the discs, capsules and ligaments seem to elicit reflex contraction of the
multifidus and also longissimus muscles. The muscular excitation is
pronounced in the level of excitation and with weaker radiation 1 to 2 levels
above and below. Similarly, mechanical stimulation of the spinal viscoelastic
tissues excites the muscles with higher excitation intensity when more than
one tissue (ligaments and discs for example) is stimulated. Overall, it seems
that spinal structures are well suited to monitor sensory information as well
as to control spinal muscles and probably also provide kinesthetic perception
to the sensory cortex.
Comment: The new and
strikingly original feature of AK is that it brings together in a functional,
inseparable manner the spinal, the nervous, and the muscle systems.
Remarkably, each system demonstrates and maintains the condition of the
other.
|
|
The effect of different standing and sitting postures on trunk muscle
activity in a pain-free population, O'Sullivan PB,
Grahamslaw KM, Kendell M, Lapenskie SC, Moller NE, Richards KV.
|
Spine. 2002 Jun
1;27(11):1238-44.
STUDY
DESIGN: A normative, single-group study was conducted. OBJECTIVE: To determine whether there is
a difference in electromyographic activation of specific lumbopelvic muscles
with the adoption of common postures in a pain-free population. SUMMARY OF BACKGROUND DATA: Clinical
observations indicate that adopting passive postures such as sway standing
and slump sitting can exacerbate pain in individuals with low back pain.
These individuals often present with poor activation of the lumbopelvic
stabilizing musculature. At this writing, little empirical evidence exists to
document that function of the trunk and lumbopelvic musculature are related
to the adoption of standardized standing and sitting postures. METHODS: This study included 20 healthy
adults, with equal representation of the genders. Surface electromyography
was used to measure activity in the superficial lumbar multifidus, internal
oblique, rectus abdominis, external oblique, and thoracic erector spinae
muscles for four standardized standing and sitting postures. RESULTS: The internal oblique,
superficial lumbar multifidus, and thoracic erector spinae muscles showed a
significant decrease in activity during sway standing (P = 0.027, P = 0.002,
and P = 0.003, respectively) and slump sitting (P = 0.007, P = 0.012, and P =
0.003, respectively), as compared with erect postures. Rectus abdominis
activity increased significantly in sway standing, as compared with erect
standing (P = 0.005). CONCLUSIONS:
The findings show that the lumbopelvic stabilizing musculature is active in
maintaining optimally aligned, erect postures, and that these muscles are
less active during the adoption of passive postures. The results of this
study lend credence to the practice of postural retraining when facilitation of the lumbopelvic stabilizing
musculature is indicated in the management of specific spinal pain
conditions.
|
|
Chiropractic
'name techniques': a review of the literature, Gleberzon BJ.
|
European Journal of Chiropractic
2002; 49: 242-3.
Abstract:
The purpose of this paper is to describe the results of a literature
search of several different chiropractic 'name techniques.' This process is
an important first step in building an evidentiary foundation upon which
clinical decisions should be made, and it further guides research efforts by
exposing those areas which are insufficiently investigated. Out of the 111
articles found in this study, 39 were technique descriptions (35%), 29 were
case studies or case series (26%), 25 were experimental studies (23%), and
only 17 (15%) were clinical trials. Out of the clinical trial, only five were
designed with a treatment group/control group and only one study was designed
with a treatment group/sham treatment group. None of these clinical trials
were designed with a treatment/sham/control group protocol. It is equally problematic
that those studies which investigated the intra- and inter-reliability of
such diagnostic tests as leg length checks or X-ray mensurations have not
linked these tests with any clinical applicability or relevance. Thus it is
fair to state that the current body of research into name techniques is still
in its infancy. Therefore, it is incumbent upon advocates of name techniques
to continue to establish an evidentiary base to support the utilization of
their diagnostic or therapeutic procedures.
Comment: Research is
one of ICAK’s priorities. The Collected
Papers of the International College of Applied Kinesiology has
been published both annually and bi-annually since the founding of the ICAK
in 1976, and are available for review on this website. The sharing of the
clinical observations and ideas in this yearly publication is the launching
of a researching idea, and a step up a path where too few in the health care
community have gone. As patient-based outcomes assessment are a growing part
of evidence-based health care throughout the healing professions, more
studies are needed that evaluate patient responses to therapy. There have
been over 2,000 papers in 40 Annual Yearbooks published by members of the
ICAK, taking the organization from its infancy toward its maturity.
|
|
Chiropractic
Name Techniques in Canada: A Continued Look at Demographic Trends and Their
Impact on Issues of Jurisprudence, Gleberzon BJ.
|
J Can Chiropr Assoc
2002; 46(4): 241-56.
Abstract:
In a previous article, the author reported on the recommendations
gathered from student projects between 1996-1999 investigating their
preferences for including certain chiropractic Name technique systems into
the curriculum at the Canadian Memorial Chiropractic College (CMCC). These
results were found to be congruent with the professional treatment techniques
used by Canadian chiropractors. This article reports on date obtained during
the 2002 and 2001 academic years, comparing these results to those previously
gathered. In addition, because of the implementation of a new curriculum
during this time period, there was a unique opportunity to observe whether or
not student perceptions differed between those students in the 'old'
curricular program , and those students in the 'new' curricular program. The
results gathered indicate that students in both curricular programs show an
interest in learning Thompson Terminal Point, Activator Methods, Gonstead,
and Active Release Therapy techniques in the core curriculum, as an elective,
or during continuing educational programs provided by the college. Students
continue to show less interest in learning CranioSacral Therapy, Sacro
Occipital Technique, Logan Basic, Applied Kinesiology and Chiropractic
BioPhysics. Over time, student interest has moved away from Palmer HIO and
other upper cervical techniques, and students show a declining interest in
being offered instruction in either Network Spinal Analysis or Torque Release
Techniques. Since these findings reflect the practice activities of Canadian
chiropractors they may have implications not only towards pedagogical
decision-making process at CMCC, but may also influence professional
standards of care.
|
|
Patients using chiropractors in North America: who
are they, and why are they in chiropractic care? Coulter ID, Hurwitz EL, Adams AH, Genovese
BJ, Hays R, Shekelle PG.
|
Spine. 2002 Feb 1;27(3):291-6;
discussion 297-8.
SUMMARY OF BACKGROUND DATA AND OBJECTIVES: Alternative health care was used by an estimated 42% of the U.S.
population in 1997, and chiropractors accounted for 31% of the total
estimated number of visits. Despite this high level of use, there is little
empirical information about who uses chiropractic care or why. METHODS: The authors surveyed randomly
sampled chiropractors (n = 131) at six study sites and systematically sampled
chiropractic patients seeking care from participating chiropractors on 1 day
(n = 1275). Surveys collected data about the patient's reason for seeking
chiropractic care, health status, health attitude and beliefs, and satisfaction.
In addition to descriptive statistics, the authors compared data between
patients and chiropractors, and between patients and previously published
data on health status from other populations, corrected for the clustering of
patients within chiropractors. RESULTS:
More than 70% of patients specified back and neck problems as their health
problem for which they sought chiropractic care. Chiropractic patients had
significantly worse health status on all SF-36 scales than an age- and
gender-matched general population sample. Compared with medical back pain
patients, chiropractic back pain patients had significantly worse mental
health (6-8 point decrement). Roland-Morris scores for chiropractic back pain
patients were similar to values reported for medical back pain patients. The
health attitudes and beliefs of chiropractors and their patients were
similar. Patients were very satisfied with their care. CONCLUSION: These data support the theory
that patients seek chiropractic care almost exclusively for musculoskeletal
symptoms and that chiropractors and their patients share a similar belief
system.
|
|
Electromyographic
reflex response to mechanical force, manually-assisted spinal manipulative
therapy, Colloca CJ, Keller TS.
|
Spine, 2001;26:1117-24
(http://www.journals.elsevierhealth.com/periodicals/ymmt/medline/record/MDLN.11413422)
Study
Design: Surface electromyographic reflex responses
associated with mechanical force, manually assisted (MFMA) spinal
manipulative therapy were analyzed in this prospective clinical investigation
of 20 consecutive patients with low back pain.
Objectives:
To characterize and determine the magnitude of electromyographic
reflex responses in human paraspinal muscles during high loading rate
mechanical force, manually assisted spinal manipulative therapy of the
thoracolumbar spine and sacroiliac joints.
Summary of Background Data:
Spinal manipulative therapy has been investigated for its effectiveness in
the treatment of patients with low back pain, but its physiologic mechanisms
are not well understood. Noteworthy is the fact that spinal manipulative
therapy has been demonstrated to produce consistent reflex responses in the
back musculature; however, no study has examined the extent of reflex
responses in patients with low back pain. Methods:
Twenty patients (10 male and 10 female, mean age 43.0 years) underwent
standard physical examination on presentation to an outpatient chiropractic
clinic. After repeated isometric trunk extension strength tests, short
duration (<5 msec), localized posteroanterior manipulative thrustswere delivered to the sacroiliac joints, and L5,
L4, L2, T12, and T8 spinous processes and transverse processes. Surface,
linear-enveloped electromyographic (sEMG) recordings were obtained from
electrodes located bilaterally over the L5 and L3 erector spinae musculature.
Force-time and sEMG time histories were recorded simultaneously to quantify
the association between spinal manipulative therapy mechanical and
electromyographic response. A total of 1600 sEMG recordings were analyzed
from 20 spinal manipulative therapy treatments, and comparisons were made
between segmental level, segmental contact point (spinous vs. transverse
processes), and magnitude of the reflex response (peak-peak [p-p] ratio and
relative mean sEMG). Positive sEMG responses were defined as >2.5 p-p
baseline sEMG output (>3.5% relative mean sEMG output). SEMG threshold was
further assessed for correlation of patient self-reported pain and
disability. Results: Consistent,
but relatively localized, reflex responses occurred in response to the
localized, brief duration MFMA thrusts delivered to the thoracolumbar spine
and SI joints. The time to peak tension (sEMG magnitude) ranged from 50 to
200 msec, and the reflex response times ranged from 2 to 4 msec, the latter
consistent with intraspinal conduction times. Overall, the 20 treatments
produced systematic and significantly different L5 and L3 sEMG responses,
particularly for thrusts delivered to the lumbosacral spine. Thrusts applied
over the transverse processes produced more positive sEMG responses (25.4%)
in comparison with thrusts applied over the spinous processes (20.6%). Left
side thrusts and right side thrusts over the transverse processes elicited
positive contralateral L5 and L3 sEMG responses. When the data were examined
across both treatment level and electrode site (L5 or L3, L or R), 95% of
patients showed positive sEMG response to MFMA thrusts. Patients with
frequent to constant low back pain symptoms tended to have a more marked sEMG
response in comparison with patients with occasional to intermittent low back
pain. Conclusions: This is the
first study demonstrating neuromuscular reflex responses associated with MFMA
spinal manipulative therapy in patients with low back pain. Noteworthy was
the finding that such mechanical stimulation of both the paraspinal
musculature (transverse processes) and spinous processes produced consistent,
generally localized sEMG responses. Identification of neuromuscular
characteristics, together with a comprehensive assessment of patient clinical
status, may provide for clarification of the significance of spinal
manipulative therapy in eliciting putative conservative therapeutic benefits
in patients with pain of musculoskeletal origin.
|
|
Sensory
motor control of the lower back: implications for rehabilitation,
Ebenbichler, G, Oddsson, L, Kollmitzer, J, Erim, Z.
|
Med Sci Sports Exer, 2001;33:1889-98
This paper described a series of studies that have been done
investigating the surface electromyography (SEMG) fatigue pattern of the back
muscles during submaximal contraction. SEMG changes correlated with erector
muscle fatigue, validating the subjective erector muscle endurance tests
against the objective SEMG. Given the results of this study, a larger
double-blind study of SEMG evaluation compared to manual muscle testing could
be done, wherein back muscles strength and endurance time during testing are
measured before and after a course of chiropractic care.
|
|
Ischemia
causes muscle fatigue, Murthy, G, Hargens, A, Lehman, S, Rempel, D.
|
J Orthop Res, 2001;19:436-440
The purpose of this investigation was to determine whether ischemia,
which reduces oxygenation in the extensor carpi radialis (ECR) muscle, causes
a reduction in muscle force production. In eight subjects, muscle oxygenation
(TO2) of the right ECR was measured noninvasively and continuously
using near infrared spectroscopy (NIRS) while muscle twitch force was
elicited by transcutaneous electrical stimulation (1 Hz, 0.1 ms). Baseline
measurements of blood volume, muscle oxygenation and twitch force were
recorded continuously, then a tourniquet on the upper arm was inflated to one
of five different pressure levels: 20, 40, 60 mm Hg (randomized order)
and diastolic (69 ± 9.8 mm Hg) and systolic (106 ± 12.8 mm Hg)
blood pressures. Each pressure level was maintained for 3–5 min, and was
followed by a recovery period sufficient to allow measurements to return to
baseline. For each respective tourniquet pressure level, mean TO2
decreased from resting baseline (100% TO2) to 99 ± 1.2% (SEM), 96
± 1.9%, 93 ± 2.8%, 90 ± 2.5%, and 86 ± 2.7%, and mean twitch force decreased
from resting baseline (100% force) to 99 ± 0.7% (SEM), 96 ± 2.7%, 93 ± 3.1%,
88 ± 3.2%, and 86 ± 2.6%. Muscle oxygenation and twitch force at 60
mm Hg tourniquet compression and above were significantly lower (P<0.05) than baseline value. Reduced
twitch force was correlated in a dose-dependent manner with reduced muscle
oxygenation (r=0.78,P<0.001). Although the correlation
does not prove causation, the results indicate that ischemia leading to a 7%
or greater reduction in muscle oxygenation causes decreased muscle force
production in the forearm extensor muscle. Thus, ischemia associated with a
modest decline in TO2 causes muscle fatigue.
|
|
Physiology of human lymphatic contractility: a historical
perspective,
Gashev AA, Zawieja DC.
|
Lymphology. 2001 Sep;34(3):124-34.
Abstract: The lymphatic
system is a transport system that has important roles in fluid/macromolecule
homeostasis, lipid absorption, metastasis and immune function. It
accomplishes these roles via the generation of a regulated lymph circulation
which is dependent upon valves and pumps to overcome the normal fluid
pressure gradients. Lymphatic contractility plays crucial roles in the
regulation and generation of lymph transport. Whereas our understanding of
lymphatic contractility in humans is somewhat limited, a number of studies
both in situ and in vitro have provided important insights into the presence
and modulation of lymphatic contractility. These studies have clearly
demonstrated that lymphatic vessels from a number of different human tissues
possess both tonic and phasic changes in contractility. These changes in
contractility are presumably involved in the generation and regulation of
lymph flow. It has been shown that human lymphatic contractility can be
influenced by a number of neural and humoral agents as a means to control
lymph transport. However our understanding of the physical and chemical
factors which regulate both the spontaneous pumping activity and the vessel
tone are more limited. An understanding of the factors which regulate human
lymph transport could provide valuable information on human biology that
could be of benefit to the treatment and prevention of diseases.
|
|
Spinal manipulation causes variable spine kinematic and trunk muscle
electromyographic responses, Lehman GJ, McGill SM.
|
Clin Biomech (Bristol, Avon). 2001
May;16(4):293-9.
STUDY DESIGN: Analytic cohort with a
convenience sample in a research clinic. OBJECTIVES:
To determine the influence of a spinal manipulation on trunk kinematics and
associated trunk myoelectric activity. SUMMARY
OF BACKGROUND: While the mechanism of spinal manipulation is
unknown, it has been theorized to influence spinal range of motion and trunk
muscle activity. METHODS: Trunk
kinematics were measured in low back pain patients (n = 14) during simple
range of motion tasks in three planes, while trunk muscle electromyogram
signals were recorded bilaterally from paraspinal and abdominal musculature.
Kinematics and electromyogram signals were assessed pre-post manipulation.
Electromyogram activity was also assessed pre-post manipulation during quiet
stance. RESULTS: While no
consistent kinematic or electromyographic changes occurred following
manipulation across the population, individual changes were observed. The largest changes (> 6 degrees ) in range of
motion occurred in the sagittal plane of three patients experiencing the
greatest amount of pain. During quiet stance 17 muscles across all subjects
exhibited changes in muscle activity following manipulation.
Sixteen of those changes were decreases in muscle amplitude. CONCLUSIONS: This study offers some
preliminary data on the short-term effects of manipulation on lumbar range of
motion and dynamic electromyogram. The findings suggest that the response to
manipulation is variable and dependent on the individual, with no change in
some to the largest changes seen in the more pained patients. Relevance.
Basic science investigations into the mechanisms and biomechanical influences
of spinal manipulation are few. This study attempts to address issues of
measureable functional change with manipulative therapy.
Comment: This study shows that
measurable changes in muscle function occur immediately after spinal
manipulation.
|
|
Prevalence of nonmusculoskeletal complaints in chiropractic practice:
report from a practice-based research program, Hawk
C, Long CR, Boulanger KT.
-- Palmer
Center for Chiropractic Research, Davenport, Iowa 52803, USA.
|
J Manipulative Physiol Ther. 2001
Mar-Apr;24(3):157-69.
OBJECTIVE: To identify
patient and practice characteristics that might contribute to people's
seeking chiropractic care for nonmusculoskeletal complaints. DESIGN: This was a cross-sectional study
conducted through the methods of practice-based research. SETTING: Data were collected in
1998--1999 in chiropractic offices in the United States, Canada, and Australia;
data were managed by a practice-based research office operating in a
chiropractic research center. POPULATION:
The subjects were new and established patients of all ages who visited the
participating offices during a designated data collection week. DATA ANALYSIS: Multiple logistic
regression was used to examine factors associated with patients' presenting
for nonmusculoskeletal chief complaints. Pearson's chi(2) test was used to
examine associations among practice variables and the proportion of patients
with nonmusculoskeletal chief complaints. RESULTS:
A total of 7651 patients of 161 chiropractors in 110 practices in 32 states
and 2 Canadian provinces participated; data from 2 Australian practices were
included in the totals but not in the analysis. Nonmusculoskeletal complaints
accounted for 10.3% of the chief complaints. The following characteristics
made patients more likely to present with nonmusculoskeletal chief
complaints: being less than 14 years of age (adjusted odds ratio [AOR], 6.9;
95% CI, 5.2--9.1); being female (AOR, 1.5; CI, 1.3--1.8); presenting in a
small town/rural location (AOR, 1.9; CI, 1.3--2.7); reporting more than 1
complaint, especially nonmusculoskeletal complaints (AOR, 4.9; CI, 3.9--6.0);
having received medical care for the chief complaint (AOR, 3.4; CI,
2.9--4.1); and having first received chiropractic care before 1960 (AOR, 1.7;
CI, 1.1--2.4). Practices with the highest proportion of patients with
nonmusculoskeletal chief complaints (>17%) were less likely to accept insurance
and more likely to be in locations with populations greater than 100,000.
They used the most common chiropractic adjustive techniques less frequently
and used more nonadjustive procedures, especially diet/nutrition counseling,
nutritional supplementation, herbal preparations, naturopathy, and
homeopathy. CONCLUSIONS: Drawing
on practices with the patient and practice characteristics identified in this
study to conduct outcomes studies on nonmusculoskeletal conditions is a
possible direction for future research.
Comment: Applied
kinesiologists theorize that specific muscles are associated with specific
areas of the body. There are organ-muscle, gland-muscle, meridian-muscle,
spine-muscle, and reflex-muscle relationships. (The relationships between
specific spinal nerves and specific muscles are taught in neurology
textbooks.) AK MMT offers a simple, non-invasive method of functional
diagnosis that incorporates many other chiropractic, osteopathic, cranial,
nutritional, manual medicine, and Traditional Chinese Medicine assessment
methods, all of which are based on the traditional and foundational
principles of chiropractic health care. AK combines many existing therapies
into one inseparable system of health care, making AK a foundation stone for
non-crisis care functional medicine.
|
|
Comparison
of effects of spinal manipulation and massage on motoneuron excitability,
Dishman J, Bulbulian R.
|
Electromyogr Clin Neurophysiol. 2001;41:97-106
Abstract: The purpose of
this study was to compare the magnitude and duration of motoneuron inhibition
occurring as a sequel to spinal manipulation or paraspinal and limb massage.
The physiologic mechanisms involved in spinal manipulative therapy and
massage therapy are largely unknown. One possible hypothesis is based upon the
theory that these two distinct and different modalities may attenuate the
activity of alpha motoneurons. Both modalities have been reported to produce
short-term inhibition of motoneurons. Asymptomatic volunteers were randomly
assigned to either a spinal manipulation, massage, or control group. Baseline
tibial nerve H-reflex amplitudes were obtained prior to the application of
either lumbosacral spinal manipulation or paralumbar and limb massage.
Post-interventional H-reflex recordings were recorded immediately following
the application of either modality. Spinal manipulation significantly (p <
0.05) attenuated alpha motoneuronal activity immediately post-therapy, as
measured by the amplitude of the tibial nerve H-reflex. Massage subjects
exhibited no significant reduction in motoneuronal activity immediately
following administration. Spinal manipulation produced a transient
attenuation of alpha motoneuronal excitability. Paraspinal and limb massage
did not inhibit the motoneuron pool as measured immediately post-therapy.
These findings support the supposition that spinal manipulation procedures
lead to short-term inhibitory effects on motoneuron excitability to a greater
magnitude than massage.
|
|
Relationship between hip muscle imbalance and
occurrence of low back pain in collegiate athletes: a prospective study, Nadler SF,
Malanga GA, Feinberg JH,
Prybicien M,
Stitik TP, DePrince
M.
|
Am J Phys Med Rehabil. 2001
Aug;80(8):572-7.
OBJECTIVE: To assess
whether athletes with strength imbalance of the hip musculature would be more
likely to require treatment for low back pain (LBP) over the ensuing year. DESIGN: The study population included 163
National Collegiate Athletic Association Division I college athletes (100
males and 63 females) undergoing preparticipation sports physicals.
Institutional review board approval was obtained to acquire and analyze hip
muscle strength data. A commercially available dynamometer (Chatillon,
Lexington, KY) incorporated into a specially designed anchoring station was
used for testing the hip extensors and abductors. The maximum force generated
for the hip abductors and extensors was used to calculate a percentage
difference between the right and left hip extensors and abductors. Treatment
of athletes by the athletic trainers for LBP unrelated to blunt trauma over
the ensuing year was recorded. RESULTS:
Of all athletes, 5 of 63 females and 8 of 100 males required treatment for
LBP. Logistic regression analysis indicated that for female athletes, the
percentage difference between the right and left hip extensors was predictive
of whether treatment for LBP was required over the ensuing year (P = 0.05).
There was no significant association noted for the percentage difference
between the right and left hip abductors in females and for the percentage
difference between both the right and left hip abductors and right and left
hip extensors in males requiring treatment for LBP. CONCLUSIONS: These data support our
results from our previous cohort study, adding
validity to the concept of hip muscle imbalance being associated with LBP
occurrence in female athletes. This
research further supports the need for the assessment and treatment of hip
muscle imbalance in individuals with LBP.
Comment: The
correlation between “inhibited” or “weak” MMT findings and low back pain has
been established in much of the research literature. This paper shows that
there is a construct validity and reliability in employing MMT testing in
patients with low back pain.
|
|
Measuring knee extensor muscle strength,
Bohannon RW.
-- Department of Physical Therapy, School of
Allied Health, University of Connecticut, Storrs 06269-2101, USA.
|
Am J Phys Med Rehabil. 2001 Jan;80(1):13-8.
OBJECTIVE: To compare manual
muscle test with hand-held dynamometer measurements of knee extension
strength. A secondary analysis of measurements (n = 256 knees) from 128 acute
rehabilitation patients was performed. DESIGN:
Knee extensor muscle testing was conducted according to the technique of
Hislop and Montgomery; 0 to 5 grades were converted to an expanded 0 to 12
scale. Dynamometry was used to measure the isometric knee extension force
with 'gravity eliminated.' RESULTS:
Manual muscle test and dynamometer measures were highly correlated (r =
0.768; P < 0.001); the correlation was higher when the quadratic nature of
the relationship was taken into account (R = 0.887; P < 0.001). Although
the dynamometer forces that were associated with different manual muscle test
grades differed overall (F = 67.736; P < 0.001), the forces associated with
some of the higher grades did not differ statistically. CONCLUSIONS: These findings reinforce the
convergent construct validity of the manual muscle test and dynamometry
measurements but challenge the discriminant construct validity of manual
muscle testing. An alternative manual muscle testing grading scheme is
suggested that provides for discriminant validity and retains convergent
validity.
|
|
Effect of knee joint effusion on quadriceps and soleus motoneuron
pool excitability, Hopkins JT, Ingersoll CD, Krause BA,
Edwards JE, Cordova ML.
|
Med Sci Sports Exerc, 2001
Jan;33(1):123-6.
PURPOSE: To examine
changes in quadriceps and soleus MN pool activity resulting from knee joint
effusion over a 4-h period and assess the relationship between the muscles. METHODS: A repeated measures before-after
trial design was used for this study. Eight, neurologically sound volunteers
(age 23.3+/-2.1 yr, height 171.8+/-15.9 cm, mass 65.5+/-17.7 kg) participated
in this study. An area superomedial to the patella was cleaned and anesthetized,
and 30 mL of sterile saline was injected into the knee joint capsule to mimic
mechanical joint effusion. The Hoffman reflex (H-reflex) was elicited by
applying a percutaneous stimulus to the appropriate nerve and recording the
response through surface electromyography. Soleus and vastus medialis
H-reflex measures were collected from each volunteer before, at 30 min, 90
min, 150 min, and 210 min intervals over a 4-h period after knee effusion. RESULTS: All soleus H-reflex measures
after effusion (30 min 5.89+/-0.92 V; 90 min 6.16+/-0.48 V; 150 min
6.59+/-0.50 V; 210 min 6.70+/-0.56 V) were increased in relation to the
preeffusion measure (5.01+/-0.79 V). All vastus medialis H-reflex measures
after effusion (30 min 4.23+/-0.94 V; 90 min 4.15 +/-1.11 V; 150 min
4.16+/-0.57 V; and 210 min 4.99+/-1.23) were decreased in relation to the
preeffusion measure (5.88+/-1.44 V; P < or = 0.05). CONCLUSIONS: Afferent activity from the knee joint capsule resulted in an inhibitory
effect on the vastus medialis and a facilitatory effect on the soleus.
Facilitation of the soleus in cooperation with other lower extremity
musculature could be a mechanism for
compensation of the inhibited quadriceps to maintain lower kinetic
chain function.
|
|
Delayed onset of electromyographic activity of vastus medialis
obliquus relative to vastus lateralis in subjects with patellofemoral pain
syndrome,
Cowan SM, Bennell KL, Hodges PW, Crossley KM, McConnell J.
|
Arch Phys Med Rehabil. 2001
Feb;82(2):183-9.
OBJECTIVE: To determine
whether electromyographic (EMG) onsets of vastus medialis obliquus (VMO) and
vastus lateralis (VL) are altered in the presence of patellofemoral pain
syndrome (PFPS) during the functional task of stair stepping. DESIGN: Cross-sectional. SETTING: University laboratory. PATIENTS: Thirty-three subjects with PFPS
and 33 asymptomatic controls. INTERVENTIONS:
Subjects ascended and descended a set of stairs-2 steps, each 20-cm high-at
usual stair-stepping pace. EMG readings of VMO and VL taken on middle stair
during step up (concentric contraction) and step down (eccentric
contraction). MAIN OUTCOME MEASURES:
Relative difference in onset of surface EMG activity of VMO compared with VL
during a stair-stepping task. EMG onsets were determined by using a computer
algorithm and were verified visually. RESULTS:
In the PFPS population, the EMG onset of VL
occurred before that of VMO in both the step up and step down phases of the
stair-stepping task (p <.05). In contrast, no such differences occurred in
the onsets of EMG activity of VMO and VL in either phase of the task for the
control subjects. CONCLUSION:
This finding supports the hypothesized relationship between changes in the
timing of activity of the vasti muscles and PFPS. This finding provides
theoretical rationale to support physiotherapy treatment commonly used in the
management of PFPS.
|
|
Quantitative study of muscle spindles in suboccipital muscles of
human fetuses, Kulkarni V, Chandy MJ, Babu KS.
|
Neurol India. 2001
Dec;49(4):355-9.
Abstract: The
proprioceptive inputs from the cervical musculature play an important role in
head-eye co-ordination and postural processes. Deep cervical muscles in
humans are shown to have high spindle content. The density, distribution and
morphology of muscle spindles were studied in superior oblique capitis,
inferior oblique capitis and rectus capitis posterior major and minor three
small suboccipital muscles. The muscles were obtained, post-mortem from
stillborn human foetus. The spindle density was calculated as the ratio of
mean spindle content to the mean wet weight of that muscle in grams. The
distribution and arrangement of spindles within the muscle and their
arrangement was studied. The spindle density of superior oblique muscle was
found to be 190, that of inferior oblique was 242 and the rectus capitis
posterior contained 98 spindles per gram of muscle. No tendon organs were
seen. The serial transverse sections of inferior oblique muscle revealed
muscle spindles of varying sizes, length varying between 100-650 microns and,
diameter 50-250 microns. A complex parallel arrangement of group of large
spindles were seen in the belly of the inferior oblique muscle, while the
polar regions contain few small isolated spindles. The relevance of such high
spindle receptor content in these tiny muscles is discussed.
Comment: Postural instability in children may contribute to various
learning and behavior problems, including attention deficit disorder and
complex developmental disorders. Many children who fall within these
categories will demonstrate significant posture and balance dysfunctions when
carefully tested. More often than not, the postural deficit is related to a
biomechanical dysfunction, which can be addressed with the proper
manipulative therapy.More than 40% of the sensors relaying proprioceptive information
are found in the cervical region. The suboccipital area is critically
important to proprioception, and it is the area most frequently faulted in
proprioceptive examination and treatment. Grostic, Sweat, and other upper
cervical chiropractic researchers have shown that joint dysfunctions of even
less than 1 mm can disturb cerebellar function, muscle function, body
posture, leg length inequalities, and nociception.
|
|
Attachments from the Spinal Dura to the
Ligamentum Nuchae: Incidence, MRI Appearance, and Strength of Attachment,
Kenin S, Humphreys BK, Hubbard B, Cramer GD
|
Proceedings
of the 2000 International Conference of Spinal Manipulation 2000;Sept:202-4
Abstract:
The identification of attachments to the posterior spinal dura from
the surrounding tissues in the cranio-cervical region by Von Lanz in 1929,
may provide the key towards a better understanding of underlying mechanisms
involved in chronic benign headaches as well as neck pain of unknown
etiology. The recent findings of
connective tissue attachments to the cervical spinal dura from muscles,
ligament, and osseous elements have sparked increasing interest among
clinicians and anatomists. However,
studies of a large number of specimens or those evaluating the MRI appearance
of these attachments have never been published. This study evaluated these attachments in 30 cadaveric spines
and then correlated the MRI appearance of the attachments to their anatomic
appearance on 4 of the specimens.
This study
identified a consistent connective tissue complex arising from within the
substance of the ligamentum nuchae, between the occiput and axis, giving rise
to 3 connective tissue bridges. Two
of the connective tissue bridges attached to the posterior spinal dura while
the third linked the rectus capitis posterior minor muscle to the ligamentum
nuchae. Of significance were: (1) The
attachment between the ligamentum nuchae and dura between C1-C2 are quite
robust. (2) The attachments between
the rectus capitis posterior minor and ligamentum nuchae usually exist. (3) The attachments between the ligamentum
nuchae and dura mater can be identified on MRI scans. These attachments may have clinical
significance in cervicogenic headache, vertigo, and flexion-extension
(whiplash) injuries, making their MRI appearance clinically important.
|
|
Conservative
lower back treatment reduces inhibition in knee-extensor muscles: a
randomized controlled trial,Suter,
E., McMorland, G., Herzog, W., Bray, R.
|
J Manipulative Physiol Ther,
2000;23:76-80
(http://www.journals.elsevierhealth.com/periodicals/ymmt/article/PIIS016147540090071X/abstract)
Background: Knee-joint pathologies, such as anterior knee pain (AKP),
are associated with strength deficits and reduced activation of the knee
extensors, which is referred to as muscle
inhibition (MI). MI is thought to prevent full functional recovery,
and treatment modalities that help to reduce or eliminate MI appear necessary
for successful rehabilitation. Clinical observations suggest that AKP is
typically associated with sacroiliac (SI) joint dysfunction. It is unknown
whether Sl-joint dysfunction contributes toknee-extensor
deficits and whether correction of SI-joint dysfunction alleviates MI. Objective: The objective of
this study was to assess whether conservative low back treatment reduces
lower limb MI. Study design: In a randomized,
controlled, double-blind study the effects of conservative lower back
treatment on knee-extensor strength and MI were evaluated in patients with
AKP. Methods: Twenty-eight
patients with AKP were randomly assigned to either a treatment or a control
group. After a lower back functional assessment, the treatment group received
a conservative treatment in the form of a chiropractic spinal manipulation
aimed at correcting SI-joint dysfunction. The control group underwent a lower
back functional assessment but received no joint manipulation. Before and
after the manipulation or the lower back functional assessment, knee-extensor
moments, MI, and muscle activation during full effort, isometric knee
extensions were measured. Results: Patients showed
substantial MI in both legs. Functional assessment revealed SI-joint dysfunction
in all subjects (23 symptomatic and 5 asymptomatic). After the SI-joint
manipulation, a significant decrease in MI of 7.5% was observed in the
involved legs of the treatment group. MI did not change in the contralateral
legs of the treatment group or the involved and contralateral legs of the
control group. There were no statistically significant changes in
knee-extensor moments and muscle activation in either group. Conclusions: The results of
this study suggest that SI-joint manipulation reduces knee-extensor MI.
Spinal manipulation may possibly be an effective treatment of MI in the lower
limb musculature.
|
|
Muscle response pattern to
sudden trunk loading in healthy individuals and in patients with chronic low
back pain, Radebold A, Cholewicki J, Panjabi MM, Patel TC.
|
Spine, 2000 Apr 15;25(8):947-54.
STUDY DESIGN: A
quick-release method in four directions of isometric trunk exertions was used
to study the muscle response patterns in 17 patients with chronic low back
pain and 17 matched control subjects. OBJECTIVES:
It was hypothesized that patients with low back pain would react to sudden
load release with a delayed muscle response and would exhibit altered muscle
recruitment patterns. SUMMARY OF BACKGROUND
DATA: A delay in erector spinae reaction time after sudden loading
has been observed in patients with low back pain. Muscle recruitment and
timing pattern play an important role in maintaining lumbar spine stability. METHODS: Subjects were placed in a
semiseated position in an apparatus that provided stable fixation of the
pelvis. They exerted isometric contractions in trunk flexion, extension, and
lateral bending. Each subject performed three trials at two constant force
levels. The resisted force was suddenly released with an electromagnet and
electromyogram signals from 12 trunk muscles were recorded. The time delay
between the magnet release and the shut-off or switch-on of muscle activity
(reaction time) was compared between two groups of subjects using two-factor
analysis of variance. RESULTS:
The number of reacting muscles and reaction times averaged over all trials
and directions showed the following results: For healthy control subjects a
shut-off of agonistic muscles (with a reaction time of 53 msec) occurred
before the switch-on of antagonistic muscles (with a reaction time of 70
msec). Patients exhibited a pattern of co-contraction, with agonists
remaining active (3.4 out of 6 muscles switched off) while antagonists
switched on (5.3 out of 6 muscles). Patients also had longer muscle reaction times
for muscles shutting off (70 msec) and switching on (83 msec) and
furthermore, their individual muscle reaction times showed greater
variability. CONCLUSIONS:
Patients with low back pain, in contrast to healthy control subjects, demonstrated a significantly different muscle
response pattern in response to sudden load release. These
differences may either constitute a
predisposing factor to low back injuries or a compensation mechanism to
stabilize the lumbar spine.
Comment: Dr. Panjabi is
the world’s most published human biomechanical researcher, with 263 published
articles to date. The hypothesis he and the other authors of this paper
present places the functionality of muscles, as both a cause and a
consequence in chronic back pain patients, at the center of a sequence of
events that ultimately results in back pain. The role of the muscular system,
as “the stabilizing system of the spine,” has been investigated by Dr.
Panjabi in numerous other papers.
|
|
Cervical muscle
dysfunction in the chronic whiplash associated disorder grade II (WAD-II),
Nederhand MJ, IJzerman MJ, Hermens HJ, Baten CT, Zilvold G.
|
Spine. 2000 Aug 1;25(15):1938-43.
STUDY DESIGN: In a
cross-sectional study, surface electromyography measurements of the upper
trapezius muscles were obtained during different functional tasks in patients
with a chronic whiplash associated disorder Grade II and healthy control
subjects. OBJECTIVES: To investigate whether muscle dysfunction of the
upper trapezius muscles, as assessed by surface electromyography, can be used
to distinguish patients with whiplash associated disorder Grade II from
healthy control subjects. SUMMARY
OF BACKGROUND INFORMATION: In the whiplash associated disorder, there is need
to improve the diagnostic tools. Whiplash associated disorder
Grade II is characterized by the presence of "musculoskeletal
signs." Surface electromyography to assess these musculoskeletal signs
objectively may be a useful tool. METHODS:
Normalized smoothed rectified electromyography levels of the upper trapezius
muscles of patients with whiplash associated disorder Grade II (n = 18) and
healthy control subjects (n = 19) were compared during three static postures,
during a unilateral dynamic manual exercise, and during relaxation after the
manual exercise. Coefficients of variation were computed to identify the
measurement condition that discriminated best between the two groups. RESULTS: The most pronounced differences
between patients with whiplash associated disorder Grade II and healthy
control subjects were found particularly in situations in which the
biomechanical load was low. Patients showed higher coactivation levels during
physical exercise and a decreased ability to relax muscles after physical
exercise. CONCLUSIONS: Patients with whiplash associated disorder Grade II
can be distinguished from healthy control subjects according to the presence
of cervical muscle dysfunction, as assessed by surface electromyography of
the upper trapezius muscles. Particularly the decreased ability to
relax the trapezius muscles seems to be a promising feature to identify
patients with whiplash associated disorder Grade II. Assessment of the muscle
(dys)function by surface electromyography offers a refinement of the whiplash
associated disorder classification and provides an indication to a suitable
therapeutic approach.
Comment: This is a very
important paper for AK. In terms of the etiology of symptoms from chronic
whiplash disorders, this study suggests that the performance of the upper
trapezius muscle is an invaluable diagnostic for musculoskeletal involvement
in chronic whiplash disorders than many of the other previous findings used
to diagnose and treat this problem. The evaluation and treatment of the upper
trapezius muscle dysfunction is a standard part of AK therapy.
|
|
Motor control problems in
patients with spinal pain: a new direction for therapeutic exercise, Jull
GA, Richardson CA.
|
J Manipulative Physiol Ther, 2000
Feb;23(2):115-7.
Abstract: Recent
research into muscle dysfunction in patients with low back pain has led to
discoveries of impairments in deep muscles of the trunk and back. These muscles have a functional role in enhancing
spinal segmental support and control. The muscle impairments are not those of strength but rather problems in
motor control. These findings call for a different approach in
therapeutic exercise, namely a motor learning exercise protocol. The specific
exercise approach has an initial focus on retraining the co-contraction of
the deep muscles (i.e., the transversus abdominis and lumbar multifidus).
Initial clinical trials point to the effectiveness of the approach in
patients with both acute and chronic low back pain in terms of reducing the
neuromuscular impairment and in control of pain.
Comment: This study
elegantly demonstrates that sensory and motor function is integrated, and
that improper sequencing of muscle groups results in disjointed movement and
pain. AK has argued from its founding that postural control is dependent upon
the ability of the individual to properly interpret sensory information and
execute an appropriate motor response. This study also demonstrates that both
acute and chronic low back pain recovers more swiftly with specific
treatments to the dysfunctional muscles.
|
|
Use of a mental rotation
reaction-time paradigm to measure the effects of upper cervical adjustments
on cortical processing: a pilot study, Kelly DD, Murphy BA, Backhouse
DP.
|
J Manipulative Physiol Ther. 2000
May;23(4):246-51.
OBJECTIVES: To investigate
the potential usefulness of a mental rotation paradigm in providing an
objective measure of spinal manipulative therapy. To determine if cortical
processing, as indicated by response time to a mental rotation reaction-time
task, is altered by an upper cervical toggle recoil adjustment. DESIGN: Prospective, double-blind,
randomized, controlled trial. SETTING:
Chiropractic college clinical training facility. PARTICIPANTS: Thirty-six chiropractic student volunteers
with clinical evidence of upper cervical joint dysfunction. INTERVENTION: Participants in the
experimental group received a high-velocity, low-amplitude upper cervical
adjustment. A non-intervention group was used to control for improvement in
the mental rotation task as a result of practice effects. Outcome measures:
Reaction time was measured for randomly varying angular orientations of an
object appearing either as normal or mirror-reversed on a computer screen. RESULTS: The average decrease in mental
rotation reaction time for the experimental group was 98 ms, a 14.9%
improvement, whereas the average decrease in mental rotation reaction time
for the control group was 58 ms, an 8. 0 improvement. The difference scores
after the intervention time were significantly greater for the experimental
group compared with the control group, as indicated by a one-tailed,
2-sample, equal variance Student t test, (P < 05). CONCLUSION: The results of this study
have demonstrated a significant improvement in a complex reaction-time task
after an upper cervical adjustment. These results provide evidence that upper
cervical adjustment may affect cortical processing.
Comment: This study
demonstrates another investigation into the potential motor control,
proprioceptive response, and functional improvements resulting from
chiropractic treatments.
|
|
Reflex
effects of subluxation: the autonomic nervous system, Budgell, B.S.
|
J Manipulative Physiol Ther,
2000;23(2):104-106
(http://www.journals.elsevierhealth.com/periodicals/ymmt/article/PIIS0161475400900769/abstract)
Background: The collective experience of the chiropractic profession
is that aberrant stimulation at a particular level of the spine may elicit a
segmentally organized response, which may manifest itself in dysfunction
within organs receiving autonomic innervation at that level. This experience
is at odds with classic views of neuroscientists about the potential for
somatic stimulation of spinal structures to affect visceral function. Objective: To review recent
findings from basic physiologic research about the effects of somatic
stimulation of spinal structures on autonomic nervous system activity and the
function of dependent organs. Data
source: Findings were drawn from a major recent review of the
literature on the influences of somatic stimulation on autonomic function and
from recent original physiologic studies concerning somatoautonomic and
spinovisceral reflexes.
Conclusions: Recent
neuroscience research supports a neurophysiologic rationale for the concept
that aberrant stimulation of spinal or paraspinal structures may lead to
segmentally organized reflex responses of the autonomic nervous system, which
in turn may alter visceral function.
Comment: Within the spinal
cord is the anterior and posterior horn. These horns are divided into five
different lamina. The spinal tracts go up and down the spinal cord within
these lamina. Lamina 2 holds the spinal tracts that supply and control the
visceral organs. Lamina 5 holds the spinal tracts that control the muscles
and the skin, carrying the nerve impulses that come from the muscles and
skin. Neuro-anatomists have discovered a neuron that connects lamina 2 to
lamina 5; it is called the alpha motor neuron. The alpha motor neuron
connecting lamina 2 and 5 means that stimulation to the skin or a muscle will
simultaneously affect the organs and vice versa. This is neurological,
anatomical proof that the muscles, organs and skin, are connected together by
the alpha motor neuron. AK physicians have found that they cannot treat one
part of the body without affecting another part of the body, which validates
what chiropractors and applied kinesiologists do. The MMT makes these types
of connections (muscle-organ, muscle-gland, muscle-joint) evident to the
patient.
|
|
Abnormalities
of the soleus H-reflex in lumbar spondylolisthesis: a possible early sign of
bilateral S1 root dysfunction, Mazzocchio R, Scarfo GB, Cartolari R,
Bolognini A, Mariottini A, Muzii VF, Palma L.
|
J Spinal Disord. 2000
Dec;13(6):487-95.
Abstract: Using routine
electrodiagnostic procedures, the authors searched for physiologic evidence
of nerve root compromise in patients with chronic mechanical perturbation to
the lumbar spine. They examined 37 patients with spondylolisthesis and various
degrees of degenerative changes in the lumbar canal. Clinical and
neurophysiologic findings were compared with data obtained from 36 healthy
persons. The soleus H-reflex appeared to be a sensitive indicator of sensory
fiber compromise at the S1 root level, because changes correlated well with
the focal sensory signs and preceded clinical and electromyographic signs of
motor root involvement. When these occurred, the clinical findings were
consistent with a more severe nerve root deficit and with radiographic
evidence of neural compression. The greater sensitivity of the soleus
H-reflex may be related to the pathophysiologic events that occur at the
lesion site.
|
|
Spinal reflex attenuation associated with spinal manipulation,
Dishman JD, Bulbulian R.
|
Spine, 2000 Oct
1;25(19):2519-24;discussion 2525.
STUDY DESIGN: This study evaluated the effect of lumbosacral spinal
manipulation with thrust and spinal mobilization without thrust on the
excitability of the alpha motoneuronal pool in human subjects without low
back pain. OBJECTIVES: To investigate the effect of high velocity, low
amplitude thrust, or mobilization without thrust on the excitability of the
alpha motoneuron pool, and to elucidate potential mechanisms in which manual
procedures may affect back muscle activity. SUMMARY OF BACKGROUND DATA: The
physiologic mechanisms of spinal manipulation are largely unknown. It has
been proposed that spinal manipulation may reduce back muscle
electromyographic activity in patients with low back pain. Although positive
outcomes of spinal manipulation intervention for low back pain have been
reported in clinical trials, the mechanisms involved in the amelioration of
symptoms are unknown. METHODS: In this study, 17 nonpatient human subjects
were used to investigate the effect of spinal manipulation and mobilization
on the amplitude of the tibial nerve Hoffmann reflex recorded from the
gastrocnemius muscle. Reflexes were recorded before and after manual spinal
procedures. RESULTS: Both spinal manipulation with thrust and mobilization
without thrust significantly attenuated alpha motoneuronal activity, as
measured by the amplitude of the gastrocnemius Hoffmann reflex. This
suppression of motoneuronal activity was significant (P < 0.05) but
transient, with a return to baseline values exhibited 30 seconds after
intervention. CONCLUSIONS: Both spinal manipulation with thrust and
mobilization without thrust procedures produce a profound but transient
attenuation of alpha motoneuronal excitability. These findings substantiate the theory that manual spinal therapy
procedures may lead to short-term inhibitory effects on the human motor
system.
Comment: This study
demonstrates that there is an immediate effect upon the motor system after
spinal manipulative therapy. This factor has been consistently demonstrated
in AK, and measuring the effect upon the motor system is made after every
manipulative treatment. Clinical conditions involving hypotonicity,
spasticity or hypertonicity are attributed to pathophysiologic abnormalities
in the motor neuron system, and this study measures this state.
|
|
Integrated jaw and neck function in man. Studies of mandibular and
head-neck movements during jaw opening-closing tasks, Zafar H
|
Swed Dent J Suppl, 2000;(143):1-41.
Abstract: This
investigation was undertaken to test the hypothesis of a functional
relationship between the human temporomandibular and craniocervical regions.
Mandibular and head-neck movements were simultaneously recorded in healthy
young adults using a wireless optoelectronic system for three dimensional
movement recording. The subjects were seated in an upright position without
head support and were instructed to perform maximal jaw opening-closing
movements at fast and slow speed. As a basis, a study was undertaken to
develop a method for recording and analysis of mandibular and head-neck
movements during natural jaw function. A consistent finding was parallel and
coordinated head-neck movements during both fast and slow jaw opening-closing
movements. The head in general started to move simultaneously with or before
the mandible at the initiation of jaw opening. Most often, the head attained
maximum velocity after the mandible. A high degree of spatiotemporal
consistency of mandibular and head-neck movement trajectories was found in
successive recording sessions. The head movement amplitude and the temporal
coordination between mandibular and head-neck movements were speed related
but not the movement trajectory patterns. Examination of individuals
suffering from temporomandibular disorders and whiplash associated disorders
(WAD) showed, compared with healthy subjects, smaller amplitudes, a diverse
pattern of temporal coordination but a similar high degree of spatiotemporal
consistency for mandibular and head-neck movements. In conclusion, the
results suggest the following: A functional linkage exists between the human
temporomandibular and craniocervical regions. Head movements are an integral
part of natural jaw opening-closing. "Functional jaw movements"
comprise concomitant mandibular and head-neck movements which involve the
temporomandibular, the atlanto-occipital and the cervical spine joints,
caused by jointly activated jaw and neck muscles. Jaw and neck muscle actions
are elicited and synchronized by neural commands in common for both the jaw
and the neck motor systems. These commands are preprogrammed, particularly at
fast speed. In the light of previous observations of concurrent jaw and head
movements during foetal yawning, it is suggested that these motor programs
are innate. Neural processes underlying integrated jaw and neck function are
invariant both in short- and long-term perspectives. Integrated jaw and neck
function seems to be crucial for maintaining optimal orientation of the gape
in natural jaw function. Injury to the head-neck, leading to WAD may derange
integrated jaw-neck motor control and compromise natural jaw function.
Comment: In AK
examination and treatment, the complexity of the TMJ apparatus is recognized.
The TMJ is part of a complex system including the bones of the skull and
cervical spine, the mandible and hyoid bone, the related muscle attachments
and other soft tissues, and neurologic and vascular components. This complex
is often referred to as the stomatognathic system. The use of AK methods,
especially challenge and therapy localization, greatly assists the
practitioner in finding concealed or hidden TMJ problems.
|
|
The craniocervical connection: a retrospective analysis of 300
whiplash patients with cervical and temporomandibular disorders, Friedman MH, Weisberg J.
|
Cranio. 2000 Jul;18(3):163-7.
Abstract: Because the
concept of whiplash as a causative factor for temporomandibular disorders
(TMD) is highly controversial, we decided to do a retrospective analysis of
patients treated in our office who had sustained whiplash injuries and were
treated for cervical and temporomandibular disorders. The records of 300
patients with TMD preceded by a motor vehicle accident were examined
retrospectively. The most common presenting symptoms, in order, were: jaw pain,
neck pain, post-traumatic headache, jaw fatigue, and severe temporomandibular
joint (TMJ) clicking. The most common TMD diagnoses were: masseter trigger
points, closing jaw muscle hyperactivity, TMJ synovitis, opening jaw muscle
hyperactivity, and advanced TMJ disk derangement. Based primarily on the
physical examination, we concluded that the TMJ and surrounding musculature
should be examined similarly to other joints, with no preconceived notion
that TMD pathology after whiplash is unlikely.
|
|
EMG and strength correlates of selected shoulder muscles during
rotations of the glenohumeral joint, David G, Magarey
ME, Jones MA, Dvir Z, Turker KS, Sharpe M.
|
Clin Biomech (Bristol, Avon). 2000
Feb;15(2):95-102.
OBJECTIVE: To identify
activation patterns of several muscles acting on the shoulder joint during
isokinetic internal and external rotation. DESIGN:
Combined EMG and isokinetic strength analysis in healthy subjects. BACKGROUND: EMG studies of the shoulder
region revealed intricate muscular activation patterns during elevation of
the arm but no parallel studies regarding pure rotations of the joint could
be located. METHODS: Fifteen
(n=30 shoulders) young, asymptomatic male subjects participated in the study.
Strength production during isokinetic concentric and eccentric internal and
external rotations at 60 and 180 degrees /s was correlated with the EMG
activity of the rotator cuff, biceps, deltoid and pectoralis major. Analysis
of the smoothed EMG related to the timing of onset of the signal and to the normalized
activity at the angle of the peak moment. Determination of the association
between the EMG and the moment was based on strength ratios. RESULTS: Findings indicated that for both
types of rotations, the rotator cuff and biceps were active 0.092+/-0.038-0.215+/-0.045
s prior to the initiation of the actual movement and 0.112-0.034 s prior to
onset of deltoid and pectoralis major activity. These differences were
significant in all of the eight conditions (P<0.05). In terms of the
strength ratios, strong association was found between electrical activity and
moment production in the subscapularis and infraspinatus (r(2)=0.95 and 0.
72, respectively) at the low and high angular velocities. CONCLUSIONS: Prior to actual rotation of
the shoulder joint, normal recruitment of the rotator cuff and biceps is
characterized by a non-specific presetting phase which is mainly directed at
enhancing the joint 'stiffness' and hence its stability. Once movement is in
progress, the EMG patterns of these muscles become movement specific and are
correlated with the resultant moment. RELEVANCE:
Muscular dysfunction relating to delayed onset activity or altered activation
patterns, due to pain, perturbed mechanics or disturbed neural activation
have been implicated as concomitant factors in other joint associated
pathologies. Through highlighting the role of the rotator cuff in shoulder
joint rotations, this study lends further support to the argument that a
parallel situation may prevail with respect to shoulder joint dysfunction.
This could lead to the development of rehabilitation protocols aimed
specifically at redressing such dysfunction.
|
|
Muscle force measured using "break"
testing with a hand-held myometer in normal subjects aged 20 to 69 years,
Phillips BA, Lo SK, Mastaglia FL.
-- Centre for Neuromuscular and Neurological
Disorders, University of Western Australia, Australian Neuromuscular Research
Institute, Perth.
|
Arch Phys Med Rehabil. 2000 Oct;81(10):1442-3.
OBJECTIVE: To measure the
strength of 17 muscle groups in the upper and lower extremities in a large
group of healthy subjects using "break" testing with a hand-held
myometer, and to examine the intrasession and intersession reliability of the
testing protocol. SUBJECTS AND
INSTRUMENTATION: A convenience sample of 20 men and 20 women in
each decade of age from 20 to 69 years (n = 200) was tested using a Penny
& Giles hand-held myometer. RESULTS:
Reliability coefficients were >.85 for both intrasession and intersession
reliability, except for the ankle dorsiflexors. Men exerted a significantly
greater force than women for all muscle groups. Age, weight, and side of
testing were significant predictors of force in the majority of muscle
groups. The fifth percentile values, as the lower limit of normal, are
reported separately for gender and side of testing for each decade of age. CONCLUSION: Using the testing protocol
specified in this study, data from patients with various neuromuscular
diseases may be compared with the appropriate gender- and age-matched normal
data to accurately identify the presence of weakness.
|
|
Hand-held dynamometry reliability in persons
with neuropathic weakness,
Kilmer DD, McCrory MA, Wright NC, Rosko RA, Kim HR, Aitkens SG.
-- Department of Physical Medicine and
Rehabilitation, School of Medicine, University of California, Davis, USA.
|
Arch Phys Med Rehabil. 2000 Nov;81(11):1538-9.
OBJECTIVE: To determine
test-retest reliability of hand-held dynamometry (HHD) in measuring strength
of persons with neuropathic weakness. DESIGN:
Intratester and intertester reliability of HHD-measured strength over a 7- to
10-day period. In addition, HHD knee strength was compared with criterion
standard of fixed dynamometry (FD). SETTING:
Human performance laboratory of a university. PARTICIPANTS: Convenience sample
of ambulatory outpatients with Hereditary Motor and Sensory Neuropathy, Type
I (HMSN) (n = 10) and able-bodied controls (CTL) (n = 11). MAIN OUTCOME MEASURE: Maximal isometric
torque. RESULTS: Intratester
intraclass correlation coefficients (ICCs) were high, generally ranging from
.82 to .96 for HHD- and FD-measured strength for both HMSN and CTL groups.
There were no significant differences between sessions for HHD-measured
strength, while FD-measured strength was only significantly different for knee
extension (p < .01). Intertester reliability was generally good for both
HHD- and FD-measured strength, with ICCs ranging from .72 to .97 for HMSN and
CTL groups. Exceptions were knee extensors and ankle dorsiflexors for the CTL
group. Knee extensor strength was significantly lower measured by HHD
compared with FD (p < .01), but knee flexor strength was similar for the
two methods. CONCLUSION: HHD
appears to be a reliable method to measure maximal isometric strength in
persons with neurogenic weakness, and may be useful to quickly and
objectively evaluate strength in the clinical setting.
|
|
The role of the motor system in spinal pain: implications for
rehabilitation of the athlete following lower back pain,
Hodges PW.
|
J Sci Med Sport. 2000
Sep;3(3):243-53.
Abstract: The purpose of
this review is to consider the role of the motor system in spinal pain. It is
well accepted that spinal stability is dependent on the contribution of the
muscular system. However, the ability of this system to satisfy the requirements
of stability is dependent on its controller--the central nervous system
(CNS). The CNS must predict the outcome of movements to plan appropriate
strategies of muscle activity to meet the demands of internal and external
forces, and initiate appropriate responses to unexpected disturbances. In
addition, this complex control of stability must occur in conjunction with
control of the trunk muscles for other functions, such as respiration. For
the CNS to cope with athletic performance the coordination of these
parameters must be streamlined. Yet evidence suggests that when spinal pain
is present the strategies used by the CNS to control trunk muscles may be
altered. The mechanism for these changes is poorly understood but may be due
to changes at many levels of the CNS. For rehabilitation of the athlete with
spinal pain it is critical that the motor control of stability is optimized.
Furthermore, this must be coordinated with the multiple other functions of
trunk muscles, including respiration.
Comment: This paper
reviews precisely many of the central tenets of AK therapy.
|
|
Effects of acupuncture, cervical manipulation and NSAID therapy on
dizziness and impaired head repositioning of suspected cervical origin: a
pilot study, Heikkila H, Johansson M, Wenngren BI.
|
Man Ther. 2000 Aug;5(3):151-7.
Abstract: In a
single-subject experiment undertaken on 14 consecutive patients, the effects
of acupuncture, cervical manipulation, no therapy, and NSAID-percutan
application on kinesthetic sensibility, dizziness/vertigo and pain were
studied in patients with dizziness/vertigo of suspected cervical origin. The
ability to perceive position of the head with respect to the trunk was
studied. The effects of different forms of therapy-and none-on dizziness and
neck pain were compared, using a 100 mm visual analogue scale (VAS). Active
head relocation by subjects with dizziness was significantly less precise
than in the control group. Manipulation was the only treatment to diminish
the duration of dizziness/vertigo complaints during the past 7 days and
increased the cervical range of motion. Both acupuncture and manipulation
reduced dizziness/vertigo on the VAS scale and had positive effects on active
head repositioning. Ketoprofen percutan application and acupuncture both
alleviated pain. The results of this study would suggest that spinal
manipulation may impact most efficiently on the complex process of
proprioception and dizziness of cervical origin.
|
|
The pain of being sick: implications of immune-to-brain communication
for understanding pain, Watkins LR, Maier SF.
|
Annu Rev Psychol. 2000;51:29-57.
Abstract: This review
focuses on the powerful pain facilitatory effects produced by the immune
system. Immune cells, activated in response to infection, inflammation, or
trauma, release proteins called proinflammatory cytokines. These
proinflammatory cytokines signal the central nervous system, thereby creating
exaggerated pain as well as an entire constellation of physiological,
behavioral, and hormonal changes. These changes are collectively referred to
as the sickness response. Release of proinflammatory cytokines by immune
cells in the body leads, in turn, to release of proinflammatory cytokines by
glia within the brain and spinal cord. Evidence is reviewed supporting the
idea that proinflammatory cytokines exert powerful pain facilitatory effects
following their release in the body, in the brain, and in the spinal cord.
Such exaggerated pain states naturally occur in situations involving
infection, inflammation, or trauma of the skin, of peripheral nerves, and of
the central nervous system itself. Implications for human pain conditions are
discussed.
Comment: In AK it has
been recognized for many years that inflammatory processes contribute to
clinical syndromes in patients. The adrenal glands (which control pro- and
anti-inflammatory processes in the body) have been an important component of
AK diagnosis and treatment, as well as other anti-inflammatory treatment
methods also (nutritional, dietary, meridian, structural, and others).
|
|
Nociceptive fingertip stimulation inhibits synergistic motoneuron
pools in the human upper limb, Leis AA, Stokic DS,
Fuhr P, Kofler M, Kronenberg MF, Wissel J, Glocker FX, Seifert C, Stetkarova
I.
|
Neurology. 2000 Nov
14;55(9):1305-9.
BACKGROUND: Activation of
distinct muscle groups organized in a stereotyped manner ("muscle
synergies") is thought to underlie the production of movement by the
vertebrate spinal cord. This results in movement with minimum effort and
maximum efficiency. The question of how the vertebrate nervous system
inhibits ongoing muscle activity is central to the study of the neural
control of movement. OBJECTIVE:
To investigate the strategy used by the human spinal cord to rapidly inhibit
muscle activation in the upper limb. METHODS:
The authors performed a series of experiments in 10 healthy subjects to
assess the effect of nociceptive cutaneous stimulation on voluntarily
contracting upper limb muscles. They recorded the electromyogram (EMG) with
surface electrodes placed over various upper limb muscles. RESULTS: The authors found evidence of a
simple inhibitory strategy that 1) was dependent on the intensity of the
stimulus, 2) was maximally evoked when stimulation was applied to the
fingertips, 3) preceded the earliest onset of voluntary muscle relaxation,
and 4) produced inhibition of EMG activity in specific upper limb muscle
groups. Nociceptive fingertip stimulation preferentially inhibited
contraction of synergistic muscles involved in reaching and grasping
(intrinsic hand muscles, forearm flexors, triceps) while having little effect
on biceps or deltoid. CONCLUSIONS:
Neural circuitry within the human spinal cord is organized to inhibit
movement by rapidly deactivating muscles that constitute distinct muscle
synergies. This strategy of selective and concurrent deactivation of the same
basic elements that produce synergistic movement greatly simplifies motor
control.
Comment: This paper
describes nociception-induced motor neuron reflex inhibition at the dorsal
horn of the spinal cord. The relationship between somatic injury and muscle
weakness is demonstrated and explained here.
|
|
Short latency inhibition of human hand motor cortex
by somatosensory input from the hand, Tokimura H, Di Lazzaro V, Tokimura Y,
Oliviero A, Profice P, Insola A, Mazzone P, Tonali P, Rothwell JC.
|
J
Physiol. 2000 Mar 1;523 Pt 2:503-13
Abstract: EMG
responses evoked in hand muscles by transcranial stimulation over the motor
cortex were conditioned by a single motor threshold electrical stimulus to
the median nerve at the wrist in a total of ten healthy subjects and in five
patients who had electrodes implanted chronically into the cervical epidural
space. 2. The median nerve stimulus suppressed responses evoked by
transcranial magnetic stimulation (TMS) in relaxed or active muscle. The
minimum interval between the stimuli at which this occurred was 19 ms. A
similar effect was seen if electrical stimulation was applied to the digital
nerves of the first two fingers. 3. Median or digital nerve stimulation could
suppress the responses evoked in active muscle by transcranial electrical
stimulation over the motor cortex, but the effect was much less than with
magnetic stimulation. 4. During contraction without TMS, both types of
conditioning stimuli evoked a cutaneomuscular reflex that began with a short
period of inhibition. This started about 5 ms after the inhibition of
responses evoked by TMS. 5. Recordings in the patients showed that median
nerve stimulation reduced the size and number of descending corticospinal volleys
evoked by magnetic stimulation. 6. We
conclude that mixed or cutaneous input from the hand can suppress the
excitability of the motor cortex at short latency. This suppression may
contribute to the initial inhibition of the cutaneomuscular reflex. Reduced
spinal excitability in this period
could account for the mild inhibition of responses to electrical brain
stimulation.
Comment: This study
demonstrates also a small part of the potentiality of the AK technique called
Therapy Localization or TL. The cutaneomuscular reflexes have been
extensively investigated in the scientific literature, and they may be a part
of the mechanism for what is found clinically with TL testing.
|
|
The role of paraspinal muscle spindles in
lumbosacral position sense in individuals with and without low back pain,
Brumagne S, Cordo P, Lysens R, Verschueren S, Swinnen S.
|
Spine. 2000 Apr 15;25(8):989-94.
STUDY
DESIGN: A two-group experimental
design with repeated measures on one factor was used. OBJECTIVES: To investigate the role of paraspinal
muscle spindles in lumbosacral position sense in individuals with and without
low back pain. SUMMARY OF BACKGROUND DATA:
Proprioceptive deficits have been identified in patients with low back pain.
The underlying mechanisms, however, are not well documented. METHODS: Lumbosacral position sense was
determined before, during, and after lumbar paraspinal muscle vibration in 23
young patients with low back pain and in 21 control subjects. Position sense
was estimated by calculating the mean absolute error, constant error, and
variable error between six criterion and reproduction sacral tilt angles. RESULTS: Repositioning accuracy was
significantly lower in the patient group than in healthy individuals
(absolute error difference between groups = 2.7 degrees, P < 0.0001).
Multifidus muscle vibration induced a significant muscle-lengthening illusion
that resulted in an undershooting of the target position in healthy
individuals (constant error = -3.1 degrees, P < 0.0001). Conversely, the
position sense scores of the patient group did not display an increase in
negative directional error but a significant improvement in position sense
during muscle vibration (P < 0.05). No significant differences in absolute
error were found between the first and last trial in the healthy individuals
(P >/= 0.05) and in the patient group (P > 0.05). CONCLUSIONS: Patients with low back pain have a less refined position sense than
healthy individuals, possibly because of an altered paraspinal muscle spindle
afference and central processing of this sensory input. Furthermore, muscle
vibration can be an interesting expedient for improving proprioception and
enhancing local muscle control.
Comment: The
treatment of myofascial gelosis and fascial tension through percussion (as
taught by Dr. Robert Fulford and applied in AK by Dr. Goodheart) has
relevance to patients with low back pain who suffer from position sense
deficits as described in this paper.
|
|
Decrease in
quadriceps inhibition after sacroiliac joint manipulation in patients with
anterior knee pain, Suter, E.,
McMorland, G., Herzog, W., Bray, R.
|
J Manipulative Physiol Ther,
1999;22:149-153
(http://www.journals.elsevierhealth.com/periodicals/ymmt/article/PIIS0161475499701284/abstract)
Background: Evidence exists that conservative rehabilitation
protocols fail to achieve full recovery of muscle strength and function after
joint injuries. The lack of success has been attributed to the high amount of
muscle inhibition found in patients with pathologic conditions of the knee
joint. Clinical evaluation shows that anterior knee pain is typically
associated with sacroiliac joint dysfunction, which may contribute to the muscle
inhibition observed in this patient group. Objective: To assess whether
sacroiliac joint manipulation alters muscle inhibition and strength of the
knee extensor muscles in patients with anterior knee pain. Design
and Setting: The effects of sacroiliac joint manipulation were
evaluated in patients with anterior knee pain. The manipulation consisted of
a high-velocity low-amplitude thrust in the side-lying position aimed at
correcting sacroiliac joint dysfunction. Before and after the manipulation,
torque, muscle inhibition, and muscle activation for the knee extensor
muscles were measured during isometric contractions using a Cybex
dynamometer, muscle stimulation, and electromyography, respectively. Participants: Eighteen patients
(mean age, 30.5 ± 13.0 years) with either unilateral (n = 14) or bilateral
(n = 4) anterior knee
pain. Results: Patients showed
substantial muscle inhibition in the involved and the contralateral legs as
estimated by the interpolated twitch technique. After the manipulation, a decrease
in muscle inhibition and increases in knee extensor torques and muscle
activation were observed, particularly in the involved leg. In patients with
bilateral anterior knee pain, muscle inhibition was decreased in both legs
after sacroiliac joint adjustment. Conclusions: Spinal
manipulation might offer an interesting alternative treatment for patients
with anterior knee pain and muscle inhibition. Because this clinical outcome
study was of descriptive nature rather than a controlled design, biases might
have occurred. Thus the results have to be verified in a randomized,
controlled, double-blinded trial before firm conclusions can be drawn or
recommendations can be made.
|
|
Cervical root compression monitoring by flexor carpi radialis
H-reflex in healthy subjects, Sabbahi M, Abdulwahab
S.
|
Spine, 1999 Jan 15;24(2):137-41.
STUDY DESIGN: One-group, pretest-postest experimental research with
repeated measures. OBJECTIVE: To determine the effect of head postural
modification on the flexor carpi radialis H-reflex in healthy subjects.
SUMMARY OF BACKGROUND DATA: H-reflex testing has been reported to be useful
in evaluating and treating patients with lumbosacral and cervical
radiculopathy. The idea behind this technique is that postural modification
can cause further H-reflex inhibition, indicating more compression of the
impinged nerve root, or recovery, indicating decompression of the root. Such
assumptions cannot be supported unless the influence of normal head postural
modification on the H-reflex in healthy subjects is studied. METHODS:
Twenty-two healthy subjects participated in this study (14 men, 8 women; mean
age, 39 +/- 9 years). The median nerve of the subjects at the cubital fossa
was electrically stimulated (0.5 msec; 0.2 pulses per second [pps] at H-max),
whereas the flexor carpi radialis muscle H-reflex was recorded by
electromyography. The H-reflexes were recorded after the subject randomly
maintained the end range of head-forward flexion, backward extension,
rotation to the right and the left, lateral bending to the right and the
left, retraction and protraction. These were compared with the H-reflex
recorded during comfortable neutral positions. Data were recorded after the
subject maintained the position for 30 seconds, to avoid the effect of dynamic
postural modification on the H-reflex. Four traces were recorded in each
position. During recording, the H-reflex was monitored by the M-response to
avoid any changes in the stimulation-recording condition. RESULTS: Repeated
multivariate analysis of variance was used to evaluate the significance of
the difference among the H-reflex, amplitude, and latency, in various head
positions. The H-reflex amplitude showed statistically significant changes (P
< 0.001) with head postural modification. All head positions, except
flexion, facilitated the H-reflex. Extension, lateral bending, and rotation
toward the side of the recording produced higher reflex facilitation than the
other positions. These results indicate that H-reflex changes may be caused
by spinal root compression-decompression mechanisms. It may also indicate
that relative spinal root decompression occurs in most head-neck postures
except forward flexion. CONCLUSIONS: Head postural modification significantly
influences the H-reflex amplitude but not the latency. This indicates that
the H-reflex is a more sensitive predictor of normal physiologic changes than
are latencies. The H-reflex modulation in various head positions may
be-caused by relative spinal root compression-decompression mechanisms.
Comment: In AK, the
cervical compaction test was developed to monitor this kind of phenomenon.
With compression upon the top of the skull, MMT will reveal weaknesses when
cervical spine subluxations, and especially cervical disc syndromes are
present. This study measures this dynamic.
|
|
Electromyographic
responses of back and limb muscles associated with spinal manipulative
therapy, Herzog, W., Scheele, D., Conway, P.J.
|
Spine, 1999;24:146-152
(http://www.spinejournal.com/pt/re/spine/abstract.00007632-199901150-00012.htm)
Study
Design: Ten young, asymptomatic male subjects underwent 11
clinically relevant spinal manipulative treatments along the length of the
spine to test the magnitude and extent of reflex responses associated with
the treatments. Objectives: To
determine the magnitude and extent of reflex responses elicited by spinal
manipulative treatments.
Summary
of Background Data: Spinal manipulative treatments have been
associated with a reflexogenic relief of pain and a loss of hypertonicity in
muscles within the treatment area. However, there is no study in which
results show the probability of occurrence or the extent of reflex responses
during spinal manipulative treatments. Methods:
Asymptomatic subjects received spinal manipulative treatments on
the cervical, thoracic, and lumbar levels and on the sacroiliac joint. Reflex
activities were measured using 16 pairs of bipolar surface electrodes placed
on the back and proximal limb musculature. The percentage of occurrence and
the extent of reflex responses in the back and proximal limb musculature were
determined. Results: Each
treatment produced consistent reflex responses in a target-specific area. The
reflex responses occurred within 50-200 msec after the onset of the treatment
thrust and lasted for approximately 100-400 msec. The responses were probably
of multireceptor origin and were elicited asynchronously. Conclusions: This is the first study in
which results show a consistent reflex response associated with spinal
manipulative treatments. Because reflex pathways are evoked systematically
during spinal manipulative treatment, there is a distinct possibility that
these responses may cause some of the clinically observed beneficial effects,
such as a reduction in pain and a decrease in hypertonicity of muscles.
|
|
Further clinical clarification of the muscle dysfunction in cervical
headache, Jull G, Barrett C, Magee R, Ho P.
|
Cephalalgia, 1999
Apr;19(3):179-85.
Abstract: The Headache Classification Committee of the
International Headache Society listed impairments in cervical muscle function
as criteria for headaches of cervical spine origin. Fifteen
subjects with cervical headache and 15 controls were tested for the frequency
of abnormal responses to passive stretching and abnormal muscle contraction.
A new test of cranio-cervical flexion was used to assess the contraction of
the deep neck flexors. Results indicated a trend towards a higher frequency
of abnormal response to passive stretching of the muscles examined in the
cervical headache group but only the upper trapezius proved significantly
different to the control group. Deep neck flexor muscle contraction was
significantly inferior in the cervical headache group. From the perspective of physical characterization of
cervical headache, it appears that response from passive stretch of muscle
may not be a strong criterion for cervical headache but deep neck flexor
performance may have potential to identify musculoskeletal involvement in
headache. The finding may also provide positive directions for
conservative treatment of cervical headache.
Comment: This is a very
important paper for AK. In terms of the etiology of headache, The Headache
Classification Committee of the International Headache Society suggests in
this study that the performance of the deep neck flexors has greater
diagnostic value for musculoskeletal involvement in headache than any other
finding.
|
|
Orthostatic intolerance
and chronic fatigue syndrome associated with Ehlers-Danlos syndrome, Rowe PC,
Barron DF,
Calkins H,
Maumenee IH,
Tong PY,
Geraghty MT
|
J Pediatr, 1999 Oct;135(4):494-9.
OBJECTIVE: To report
chronic fatigue syndrome (CFS) associated with both Ehlers-Danlos syndrome
(EDS) and orthostatic intolerance. STUDY
DESIGN: Case series of adolescents referred to a tertiary clinic
for the evaluation of CFS. All subjects had 2-dimensional echocardiography,
tests of orthostatic tolerance, and examinations by both a geneticist and an
ophthalmologist. RESULTS: Twelve
patients (11 female), median age 15.5 years, met diagnostic criteria for CFS
and EDS, and all had either postural tachycardia or neurally mediated
hypotension in response to orthostatic stress. Six had classical-type EDS and
6 had hypermobile-type EDS. CONCLUSIONS:
Among patients with CFS and orthostatic intolerance, a subset also has EDS.
We propose that the occurrence of these syndromes together can be attributed
to the abnormal connective tissue in dependent blood vessels of those with
EDS, which permits veins to distend excessively in response to ordinary
hydrostatic pressures. This in turn leads to increased venous pooling and its
hemodynamic and symptomatic consequences. These observations suggest that a
careful search for hypermobility and connective tissue abnormalities should
be part of the evaluation of patients with CFS and orthostatic intolerance
syndromes.
Comment: The biomedical
literature on orthostatic hypotension (a positive Ragland’s sign) is very
extensive, and has been a part of standard AK evaluation of patients since
1965 when Dr. Goodheart first pointed out the significance of Adrenal Stress
Disorder among chiropractic patients. Most chronic health disorders involving
any of the three aspects of the triad of health (structural, chemical,
mental) will demonstrate some involvement of the adrenal glands, and complete
recovery from a chronic health disorder may require treatment of the adrenal
stress disorder that may be present.
|
|
Manual Muscle Testing combined
with Specific Head Positioning, and other Articular Challenges, as an
Assessment of Vertebral Subluxation of the Upper Cervical Spine: A
Descriptive Paper,
Dobson GJ.
|
J Vertebral Subluxation Res,1999;3(2):1-7.
Abstract: This article
presents the Dobson Muscle Testing (DMT) procedure. Those aspects of the
procedure as it relates to other indicators of vertebral subluxation and
other methodologies are described.The procedure detects abberant cervical
joint dynamics (movement) through muscle challenges used in combination with
various head positions, designed to functionally engage specific articular
levels, (positioning) and other articular challenges. In the cervical spine
joints and soft tissue there are a large number of mechanoreceptors. Thus, it
is postulated that in the presence of vertebral subluxation, when abberant
joint mechanics affect these mechanoreceptors, the application of the head
postioning challenges produces a barrage of noxious or inappropriate impulses
through the cerebellovestibular regulatory circuits. This is believed to
result in poor quality motor responses, which may be detected with the DMT
procedure through manual muscle testing.The DMT procedure is described as a
complement to other forms of vertebral subluxation assessment.To date,
clinical observations suggest a positive correlation to Blair upper cervical
radiographic analysis in addition to other indicators including muscle and motion
palpation and leg length analysis. Further study is planned to test the
validity of these observations through controlled studies.
|
|
Sacroiliac
joint involvement in activation of the porcine spinal and gluteal
musculature,Indahl, A.,
Kaigle, A., Reikeras, O., Holm, S.H.
|
J Spinal Disord, 1999;12:325-30
Abstract: This experiment
involved stimulation of the sacroiliac joint that was found to cause
neuromuscular responses in the gluteus maximus, quadratus lumborum, and
multifidus muscles. This muscular activation was found to assist in the
control of locomotion and body posture and to provide stability to the
sacroiliac joint and lumbar spine. Thus, sensitization of sacroiliac joint
nociceptive afferents were suggested to not only contribute to mechanical low
back pain, but plays a role also in sacroiliac joint biomechanics via
reflexogenic activation of the trunk and gluteal muscles.
Comment: Given the
results of this study, a larger double-blind study evaluating sacroiliac
joint biomechanics in relationship applied kinesiology diagnostic procedures
for the sacroiliac joint could be done, wherein back muscles strength tests
are measured before and after a course of chiropractic care for the
sacroiliac joints.
|
|
Shoulder
muscle co-ordination during chronic and acute experimental neck-shoulder
pain. An occupational pain study,
Madeleine P, Lundager B, Voigt M, Arendt-Nielsen L.
|
Eur J Appl Physiol Occup Physiol. 1999
Jan;79(2):127-40.
Abstract: Little is known
about the mechanisms leading to chronic neck-shoulder musculoskeletal
disorders (MSD). The aim of the present study was to investigate and compare
motor function during controlled, low load, repetitive work together with
chronic or acute experimental neck-shoulder pain. The clinical study was
performed on workers with (n = 12) and without (n = 6) chronic neck-shoulder
pain. In the experimental study, experimental muscle pain was induced in
healthy subjects by intra-muscular injection of hypertonic saline into the
trapezius muscle (n = 10). The assessed parameters related to motor
performance were: work task event duration, cutting forces, surface
electromyogram (EMG) activity in four shoulder muscles, displacement of the
center of pressure, and arm and trunk 3D movements. For controlled cutting
force levels, chronic and acute experimental pain provoked a series of
changes: a decreased working rhythm and a protective reorganization of muscle
synergy (experimental study), higher EMG frequency contents which may
indicate altered motor unit recruitment, and greater postural activity and a
tendency towards increased arm and trunk movements. These pain-related
changes can play a role in the development of MSD. The present clinical and
experimental study demonstrated similar interactions between motor
co-ordination and neck-shoulder pain in occupational settings. We therefore
suggest that this experimental model can be used to study mechanisms related
to MSD. Information on such modulatory processes may help in the design of
new strategies aimed at reducing the development of MSD.
|
|
Thoracic position effect
on shoulder range of motion, strength, and three-dimensional scapular
kinematics, Kebaetse M,
McClure P, Pratt NA.
|
Arch Phys Med Rehabil. 1999
Aug;80(8):945-50
OBJECTIVES: To determine
the effect of thoracic posture on scapular movement patterns, active range of
motion (ROM) in scapular plane abduction, and isometric scapular plane
abduction muscle force. STUDY DESIGN AND
METHOD: Repeated measures design. There were 34 healthy subjects
(mean age, 30.2 yrs). Each subject was positioned and stabilized while
sitting in both erect and slouched trunk postures. In each sitting posture a
three-dimensional electromechanical digitizer was used to measure thoracic
flexion and scapular position and orientation in three planes. Measurements
were taken with the arm (1) at the side, (2) abducted to horizontal in the
scapular plane, and (3) at maximum scapular plane abduction. In each posture,
isometric abduction muscle force was measured with the arm at the side and
abducted to horizontal in the scapular plane. RESULTS: In the slouched posture, the scapula was
significantly more elevated in the interval between 0 to 90 degrees
abduction. In the interval between 90 degrees and maximum abduction, the
slouched posture resulted in significantly less scapular posterior tilting.
There was significantly less active shoulder abduction ROM in the slouched
posture (mean difference = 23.6 degrees +/- 10.7 degrees). Muscle force was
not different between slouched and erect postures with the arm at the side,
but with the arm horizontal muscle force was decreased 16.2% in the slouched
position. CONCLUSION: Thoracic spine position significantly affects
scapular kinematics during scapular plane abduction, and the slouched posture
is associated with decreased muscle force.
|
|
Hand-grip strength predicts incident disability in non-disabled older
men, Giampaoli S, Ferrucci L, Cecchi F, Lo Noce C, Poce A, Dima F,
Santaquilani A, Vescio MF, Menotti A.
|
Age Ageing. 1999
May;28(3):283-8.
OBJECTIVES:
To verify if hand-grip performance in older men is a predictor of disability.
DESIGN: Population-based
prospective study. SETTING: A
sample from the Italian rural cohorts of the FINE study (Finland, Italy,
Netherlands Elderly), representative of the general population of elderly men
surveyed in 1991 and 1995. PARTICIPANTS:
140 men aged 71-91 years who reported no disability in performing activities
of daily living (ADLs), instrumental activity of daily living (IADLs) and
mobility activities at baseline examination and provided information on their
functional status at follow-up 4 years later. MEASUREMENTS: Disability was defined as needing help in
performing ADLs, IADLs and mobility. Hand-grip strength was evaluated at
baseline by a mechanical dynamometer. RESULTS:
After adjusting for potential confounding variables, a lower concentration of
high-density lipoprotein cholesterol was the only factor predicting
disability in men aged 76 years or younger and only reduced hand-grip
strength predicted incident disability in men 77 years or older. CONCLUSION: Poor hand strength as
measured by hand-grip is a predictor of disability in older people. The
hand-grip test is an easy and inexpensive screening tool to identify elderly
people at risk of disability.
Comment:
This study demonstrates that muscular strength is a predictor of disability
in older people.
|
|
EMG
recordings of abdominal and back muscles in various standing postures:
validation of a biomechanical model on sacroiliac joint stability, Snijders, C.J., Ribbers, M.T., de
Bakker, H.V., Stoeckart, R., Stam, H.J.
|
J Electromyogr Kinesiol,
1998;8:205-14
Abstract: In a
biomechanical model we described that for stability of the flat sacroiliac
joints (SIJ) muscle forces are required which press the sacrum between the
two hip bones (self-bracing). Shear loading of these joints is caused by
gravity and longitudinally oriented muscles. Protection against shearing can
come from transversely oriented muscles like the internal oblique (OI)
abdominal muscles. For validation we used standing postures with
significantly more or less OI activity compared to activity in a standardized
erect standing reference posture. OI activity decreased significantly when
(a) resting on one leg (the contralateral), as can be observed at bus stops,
(b) tilting the pelvic backward and (c) applying a pelvic belt. We explain
this decrease of OI activity by, respectively, decrease of gravity load,
decrease of load from the psoas major muscles, and a substitute of
self-bracing. The outcome of this study is in line with the biomechanical
model on SIJ stability. Clinical relevance of this study regards aspecific
low back pain and is found in the effect of the use of a pelvic belt, of a
trunk position as adopted when wearing a small rucksack and of the benefit of
exercising trunk muscles in extension and torsion.
|
|
The
intra-examiner reliability of manual muscle testing of the hip and shoulder
with a modified sphygmomanometer: a preliminary study of normal, Perossa DR,
Dziak M, Vernon HT, Hayashita K.
|
J Can Chiropr Assoc,
Jun 1998;42:2.
|
|
The
Anatomical Basis for the Effectiveness of Chiropractic Spinal Manipulation in
Treating Headache, Hack G
|
Proceedings of the 1998 International Conference on Spinal Manipulation: Vancouver, British Columbia, Canada July 16-19;1998:114-15
Abstract: While the notion that headache may arise from neck structures is new to some medical practitioners, it is a concept widely accepted by the chiropractic profession. Chiropractors regularly perform manipulative procedures involving the cervical spine to relieve headache. Interestingly, an increasing body of literature relates headaches to pathology affecting the cervical spine and a number of clinical trials have demonstrated that chiropractic spinal manipulation directed at the neck I valuable for managing headaches. One possible anatomical basis could be a recently identified muscle-dura (myodural) bridge located at the craniocervical junction. |
|
Cervicocephalic kinesthetic sensibility, active
range of cervical motion, and oculomotor function in patients with whiplash
injury, Heikkila
HV,
Wenngren BI.
|
Arch
Phys Med Rehabil. 1998 Sep;79(9):1089-94
OBJECTIVE: To
investigate cervicocephalic kinesthetic sensibility, active range of cervical
motion, and oculomotor function in patients with whiplash injury. DESIGN: A 2-year review of consecutive
patients admitted to the emergency unit after whiplash injury. SETTING: An otorhinolaryngology
department. PATIENTS AND SUBJECTS:
Twenty-seven consecutive patients with diagnosed whiplash injury (14 men and
13 women, mean age, 33.8yrs [range, 18 to 66yrs]). The controls were healthy
subjects without a history of whiplash injury. MAIN OUTCOME MEASURES: Oculomotor function was tested at 2
months and at 2 years after whiplash injury. The ability to appreciate both
movement and head position was studied. Active range of cervical motion was
measured. Subjective intensity of neck pain and major medical symptoms were
recorded. RESULTS: Active head
repositioning was significantly less precise in the whiplash subjects than in
the control group. Failures in oculomotor
functions were observed in 62% of subjects. Significant
correlations occurred between smooth pursuit tests and active cervical range
of motion. Correlations also were established between the oculomotor test and
the kinesthetic sensibility test. CONCLUSION:
The results suggest that restricted
cervical movements and changes in the quality of proprioceptive information
from the cervical spine region affect voluntary eye movements. A
flexion/extension injury to the neck may result in dysfunction of the
proprioceptive system. Oculomotor
dysfunction after neck trauma might be related to cervical afferent input
disturbances.
Comment: Several
recent reviews and articles on eye muscle proprioception agree that there is
abundant evidence that the brain utilizes information from the eye muscle
proprioceptors for balance and postural control. In applied kinesiology
chiropractic methodology, a means for testing the integration of the muscles
in the body with the visual reflexes has been termed ocular lock. It
demonstrates the failure of the eyes to work together on a binocular basis
through the cardinal fields of gaze.
This is usually not gross pathology of cranial nerves III, IV, and VI;
rather it is poor functional organization. Mechanical irritation of cranial
nerves III, IV, or VI (usually VI) may be responsible for disturbed binocular
function leading to discordant sensory inputs from the visual righting
reflex. When the eyes are turned in a specific direction, a previously strong
indicator muscle will weaken when the ocular lock test is positive, and there
is probably disturbance in the visual righting, vestibulo-ocular, or
opto-kinetic reflexes. The relevance
of the eyes to movement disorders, especially after whiplash trauma, is
described in this report.
|
|
Dialogue between the CNS and the immune system in
lymphoid organs, Straub RH, Westermann J, Scholmerich J, Falk W
|
Immunol Today, 1998 Sep;19(9):409-13.
Abstract: It is well known
that the CNS influences the responses of the immune system via humoral
substances such as cortisol. Here, Rainer Straub and colleagues discuss
aspects of the local interaction between nerves and immune cells in lymphoid
organs. They provide evidence for chemically mediated transmission between
nerves and immune cells in the spleen that is modified by the
microenvironment.
Comment: The close
association of autonomic nerve terminals with macrophages and lymphocytes
facilitates a chemically mediated transmission between nerves and immune cells.
This study strongly suggests that spinovisceral reflex effects might include
alterations in the functional activity of cells in the immune and/or
inflammatory responses. It is demonstrable with MMT that there is a
relationship between the immune system and the muscular, adrenal, and nervous
systems. The doctor and the patient can detect this interplay during MMT, and
therapy for immune dysfunction resulting from nervous system dysfunction
appropriately employed.
|
|
The effect of upper cervical or sacroiliac
manipulation on hip flexion range of motion, Pollard H, Ward G.
|
J
Manipulative Physiol Ther. 1998 Nov-Dec;21(9):611-6.
OBJECTIVES: To compare
the effectiveness of an upper cervical manipulation and a manipulation of the
sacroiliac joint for increasing hip range of motion. DESIGN: Clinical cohort
study. SETTING: Macquarie
University Centre for Chiropractic Outpatient Clinic. SAMPLE: Fifty-two randomly chosen
university students aged 18 to 34 yr. METHOD:
A reliable hand-held dynamometer was used to determine the end point of range
of motion before and after the application of a treatment. Three groups of
subjects were created: cervical manipulation, sacroiliac manipulation and
sham/placebo. Range of motion of the hip in flexion (SLR) was used as the
independent variable. RESULTS:
The two manipulative treatments resulted in increased flexion range of motion
at the hip. Statistical analysis revealed that only the upper cervical
manipulation procedure increased hip flexion range of motion significantly. CONCLUSION: The results suggest that manual therapy of the neck may affect hip
range of motion in normal adults. Findings such as these may indicate the
existence of a link between the cervical spine and the lower extremity.
Comment: In fact, AK
research and experience has shown this relationship since its beginning.
Upper cervical subluxations and fixations have been specifically correlated
with weakness of the iliopsoas and gluteus maximus muscles. And muscle
weakness is frequently the cause of a decreased ROM on testing the
extremities, low back and neck.
|
|
High cervical stress and
apnoea, Koch LE, Biedermann H, Saternus KS.
|
Forensic Sci Int. 1998 Oct 12;97(1):1-9.
Abstract:
The aim of this study was to investigate vegetative reactions in
infants after mechanical irritation of the suboccipital region. The
investigation is based on 199 infants who were observed while being treated
with a suboccipital impulse (manual therapy). The results revealed vegetative
reactions in more than half of all cases (52.8%, n = 105). The frequency of
such vegetative reactions observed was at follows: flush 48.7% (n = 97),
apnoea 22.1% (n = 44), hyperextension 13% (n = 26), and sweating 7.5% (n =
15). It is pointed out that approximately 25% of all the infants examined
reacted by apnoea due to a mechanical irritation of the suboccipital region.
This symptom was part of an extensive vegetative reaction. This method of
inducing an apnoea has not yet been described; from this it follows that
there are close relations to sudden infant death.
|
|
Rearfoot-forefoot
orientation and traumatic risk for runners, Busseuil C, Freychat P,
Guedj EB, Lacour JR.
|
Foot Ankle Int. 1998 Jan;19(1):32-7.
Abstract: Factors
making runners more susceptible to injuries were identified with a
comparative study between a healthy control group (216) and runners (66)
suffering from overuse pathology. On static and dynamic footprint, the angles
alpha0 (static) and alpha1 (dynamic) between heel and forefoot have been
measured. Analysis showed that the injured subjects have a more pronated foot
than control group subjects. These results suggest that the pronating foot
configuration would be an injury risk factor.
Comment: The
importance of proper foot function to the gait cycle has been described
previously. Specifically, the researchers looked at runners who needed
treatment for iliotibial band syndrome, Achilles tendonitis, stress fracture
of the tibia, tibial periostitis and plantar fascitis. The significant
correlation between these problems and runners with foot dysfunction shows
the importance of thorough investigation of the feet in runners with
injuries. The many factors that come into play for normal foot function are
purposely incorporated into AK examination of the feet.
|
|
The Role of
the Chiropractic Adjustment in the Care and Treatment of 332 Children with
Otitis Media, Fallon, J.
|
Journal of Clinical Chiropractic Pediatrics, 1997 Oct; 2(2) :167-83
Objective: To conduct a
pilot study of chiropractic adjustive care on children with otitis media
using tympanography as an objectifying measure, and to propose possible
mechanisms whereby subluxation is implicated in the pathophysiology of otitis
media. Design: Case series Setting: Subjects presented in a private
clinical practice in New Rochelle, New York. The subjects were referred by
various sources including pediatricians, other MDs, chiropractors and
parents. Participants: 332
children who presented consecutively with previously diagnosed otitis media,
ages 27 days to 5 years. Main Outcome
Measures: A survey of the parent/guardian was used to determine
historical data with respect to previous otitis media bouts, age of onset of
initial otitis media, feeding history, history of antimicrobial therapy,
referral patterns, and birth history. Otoscopic and tympanographic data was
collected as well as data concerning the number of adjustments administered
to produce resolution of the otitis media. Data with respect to recurrence
rates over six months was also collected. Results:
The average number of adjustments administered by types of otitis media were
as follows: acute otitis media (n=127) 4.0±1.03, chronic/serous otitis media
(n=104) 5.1±1.53, for the mixed type of bilateral otitis media (n=10)
5.3±1.35 and where no otitis was initially detected on otoscopic and tympanographic
exam (but with history of multiple bouts) (n=74) 5.88±1.87. The number of
days it took to normalize the otoscopic examination was for acute 6.67±1.9
chronic/serous 8.57±1.96, and 10.18±3.39, and mixed 10.9±2.02. The overall
recurrence rate over a six month period from initial presentation in the
office was for acute 11.02%, chronic/serous 16.34%, for mixed 30% and for
none present 17.56%. Conclusion:
To our knowledge this is the first time that tympanography has been used as
an objectifying tool with respect to the efficacy of the chiropractic
adjustment in the treatment of children with otitis media. As tympanography
has been used extensively in the medical assessment of children with otitis
media, it also serves as a bridge from which the chiropractic field and the
medical field can begin to communicate with respect to otitis media. The
results indicate that there is a strong correlation between the chiropractic
adjustment and the resolution of otitis media for the children in this study.
Normal cranial molding, which is essential for the proper juxtaposition of
the cranial bones, often does not occur in the case of a birth malposition,
as well as in the case of the child born with the aid of a C- section. This
pilot study can now serve as a starting point from which the chiropractic
profession can begin to examine its role in the treatment of children with
otitis media. Large-scale clinical trials need to be undertaken in the field
using tympanography as an objectifying measure. In addition, the role of the
occipital adjustment needs to be examined. This study begins the process of
examining the role of the vertebral cranial subluxation complex in the
pathogenesis of otitis media, and the efficacy of the chiropractic adjustment
in its resolution.
|
|
Reduced
muscle function in patients with osteoarthritis, Fisher NM, Pendergast DR.
--
Department of Rehabilitation Medicine, State University of New York at
Buffalo, USA.
|
Scand J Rehabil Med.1997
Dec;29(4):213-21
Abstract:
The purpose of this study was to determine whether subjects with knee
osteoarthritis (OA) had reduced muscle strength at various muscle lengths,
endurance, contraction velocity and functional capacity, compared with
control subjects and whether the decrease was related to functional capacity.
Forty-five men and 45 women with knee OA were compared with a control group
(41 males, 63 females) of similar age for functional capacity, maximal
isometric strength (in vivo length-tension relationship) and endurance (in
vivo force-time relationship) of knee flexion and extension and maximal
angular velocity (in vivo force-velocity relationship) of knee extension. The
OA subjects had increased difficulty (2.03 +/- 0.53) and pain (1.65 +/- 0.29)
for activities of daily living (ADLs) and significantly lower strength for
extension (72%) and flexion (56%), endurance for the quadriceps (203%) and
hamstrings (214%) and velocity (128%). The reductions were greater at longer
muscle lengths. These data demonstrate that patients with knee OA have
reduced muscle function and functional capacity compared to controls.
|
|
Muscle inhibition
following knee injury and disease, Herzog W, Suter E.
|
Sportverletz Sportschaden,
1997 Sep;11(3):74-8.
Abstract: It has been
observed that knee extensor muscles cannot be fully activated during
voluntary contractions following knee injuries. This muscle inhibition has an
unknown origin and appears to hinder full rehabilitation of the affected
joint. We have investigated muscle inhibition during and following knee
injuries in non-athletic and athletic patients and compared their results to
non-athletic, unaffected volunteer subjects. There appears to be a small
amount of muscle inhibition in the knee extensors of normal subjects; this
inhibition increases dramatically following knee injury, and appears to go
back to normal levels following surgical intervention, aggressive
physiotherapy, or a sufficient amount of time. Depending on the intervention,
strength deficits of the affected compared to the unaffected knee extensor
muscles may persist. Aggressive physiotherapy can eliminate strength deficits
following knee injury through an increased ability to recruit the knee
extensors in patients more completely compared to normal subjects.
Comment: The
correlation between joint injury to the knee and muscle inhibition found upon
muscle testing is very clearly described here. This is a central tenet of AK,
i.e. that joint injuries will produce muscle weakness that can be
specifically diagnosed and treated. On a clinical basis, AK physicians find this
consistently when testing patients with knee injuries. Manual therapy is
shown in this paper to improve the strength of muscles supporting the knee,
and led to an improvement in function and a decrease in pain for these
patients.
|
|
Athletic performance and
physiological measures in baseball players following upper cervical
chiropractic care: a pilot study, Schwartzbauer J, Kolber J, et al.
|
J Vertebral Subluxation Res, 1997;1(4):33-39.
Abstract: This study
analyzed the athletic performance in baseball players following upper
cervical chiropractic care. Twenty-one male university baseball players free
from physical injury completed the study, nine in the chiropractic group and
twelve in the control group. The control group did not receive chiropractic
care. The subluxations were determined from radiographic analysis and the
Palmer toggle-recoil adjustment in side posture with a drop head piece was
employed. The results showed significant improvement (p < 0.05) at
fourteen weeks of care in muscle strength (repetitive shoulder abduction),
long jump distance, and capillary counts in the group receiving adjustments.
|
|
Stabilizing function of
trunk flexor-extensor muscles around a neutral spine posture, Cholewicki
J, Panjabi MM, Khachatryan A
|
Spine, 1997 Oct
1;22(19):2207-12.
STUDY
DESIGN: This study examined the coactivation of trunk
flexor and extensor muscles in healthy individuals. The experimental
electromyographic data and the theoretical calculations were analyzed in the
context of mechanical stability of the lumbar spine. OBJECTIVES: To test a set of hypotheses
pertaining to healthy individuals: 1) that the trunk flexor-extensor muscle
coactivation is present around a neutral spine posture, 2) that the
coactivation is increased when the subject carries a load; and 3) that the
coactivation provides the needed mechanical stability to the lumbar spine. SUMMARY OF BACKGROUND DATA:
Theoretically, antagonistic trunk muscle coactivation is necessary to provide
mechanical stability to the human lumbar spine around its neutral posture. No
experimental evidence exists, however, to support this hypothesis. METHODS: Ten individuals executed slow
trunk flexion-extension tasks, while six muscles on the right side were
monitored with surface electromyography: external oblique, internal oblique,
rectus abdominus, multifidus, lumbar erector spinae, and thoracic erector
spinae. Simple, but realistic, calculations of spine stability also were
performed and compared with experimental results. RESULTS: Average antagonistic flexor-extensor muscle
coactivation levels around the neutral spine posture as detected with
electromyography were 1.7 +/- 0.8% of maximum voluntary contraction for no
external load trials and 2.9 +/- 1.4% of maximum voluntary contraction for
the trials with added 32-kg mass to the torso. The inverted pendulum model
based on static moment equilibrium criteria predicted no antagonistic
coactivation. The same model based on the mechanical stability criteria
predicted 1.0% of maximum voluntary contraction coactivation of flexors and
extensors with zero load and 3.1% of maximum voluntary contraction with a
32-kg mass. The stability model also was run with zero passive spine
stiffness to simulate an injury. Under such conditions, the model predicted
3.4% and 5.5% of maximum voluntary contraction of antagonistic muscle
coactivation for no extra load and the added 32 kg, respectively. CONCLUSIONS: This study demonstrated that
antagonistic trunk flexor-extensor muscle coactivation was present around the
neutral spine posture in healthy individuals. This coactivation increased
with added mass to the torso. Using a biomechanical model, the coactivation
was explained entirely on the basis of the need for the neuromuscular system
to provide the mechanical stability to the lumbar spine.
Comment: AK
demonstrates that muscle imbalance is most often primary to structural and
postural deviations, from vertebral subluxations to obvious postural
imbalances. Early in AK it was recognized that the short or hypertonic muscle
is frequently secondary to poor function of its antagonist muscle. On MMT the
antagonist muscle tests weak, indicating that the coactivation necessary for
pain free function and, as in this study, neutral spine posture.
|
|
Muscle function and gait in patients with knee osteoarthritis
before and after muscle rehabilitation, Fisher NM, White SC, Smolinski RJ,
Pendergast DR.
|
Disabil and Rehabil.1997
Feb;19(2):47-55
Abstract:
Patients with knee osteoarthritis (OA) have reduced functional
capacity and muscle function that improves significantly after quantitative
progressive exercise rehabilitation (QPER). The effects of these changes on
the biomechanics of walking have not been quantified. Our goal was to
quantify the effects of knee OA on gait before and after QPER. Bilateral kinematic
and kinetic analyses were performed using a standard link-segment analysis on
seven women (60.9 +/- 9.4 years) with knee OA. All functional capacity,
muscle function and gait variables were initially reduced compared to
age-matched controls. Muscle strength, endurance and contraction speed were
significantly improved (55%, 42% and 34%, respectively) after 2 months of
QPER (p < 0.05), as were function (13%), walking time (21%), difficulty
(33%) and pain (13%). There were no significant changes in the gait variables
after QPER. To use the QPER improvements to the best advantage, gait
retraining may be necessary to "re-programme' the locomotor pattern.
|
|
Spinal manipulation
results in immediate H-reflex changes in patients with unilateral disc
herniations, Floman Y, Liram N, Gilai AN.
|
Eur Spine J. 1997;6(6):398-401.
Abstract: The aim of
this clinical investigation was to determine whether the abnormal H-reflex
complex present in patients with S1 nerve root compression due to lumbosacral
disc herniation is improved by single-session lumbar manipulation.
Twenty-four patients with unilateral disc herniation at the L5-S1 level
underwent spinal H-reflex electro-physiological evaluation. This was carried
out before and after single-session lumbar manipulation in the side-lying
position. Eligibility criteria for inclusion in the study were: predominant
sciatica, no motor or sphincteric involvement, unilateral disc herniation at
the L5-S1 level on CT or MR imaging, age between 20 and 50 years. H-reflex
responses were recorded bilaterally from the gastrosoleus muscle following
stimulation of tibial sensory fibers in the popliteal fossa. H-reflex
amplitude in millivolts (HR-A) and H-reflex latency in milliseconds (HR-L)
were measured from the spinal reflex response. Pre- and post-manipulation
measurements were compared between the affected side and the healthy side.
Statistical evaluation was performed by the Wilcoxon matched-pairs test
(SPSS). Thirteen patients displayed abnormal H-reflex parameters prior to
lumbar manipulation, indicating an S1 nerve root lesion. The mean amplitude
was found to be significantly lower on the side of disc herniation than on
the normal, healthy side (P = 0.0037). Following manipulation, the abnormal
HR-A increased significantly on the affected side while the normal HR-A on
the healthy side remained unchanged (P = 0.0045). There was a significant
difference between latencies on the affected side and those on the healthy
side (P = 0.003). Following manipulation there was a trend toward decreased
HR-L. However, this trend did not reach statistical significance (P =
0.3877). Eight patients displayed no H-reflex abnormalities before or after
manipulation. Their respective HR-A and HR-L values did not change
significantly following manipulation. Three additional patients were excluded
due to technical difficulties in achieving manipulation or measuring spinal
reflex. These observations may lend physiological support for the clinical
effects of manipulative therapy in patients with degenerative disc disease.
|
|
Chronic neck pain,
standing balance, and suboccipital muscle atrophy--a pilot study, McPartland
JM, Brodeur RR, Hallgren RC.
|
J Manipulative Physiol Ther.
1997 Jan;20(1):24-9.
OBJECTIVE: To study the
relationship between chronic neck pain, standing balance and suboccipital
muscle atrophy. We hypothesize that patients with chronic neck pain have more
somatic dysfunction in the cervical spine than control subjects without neck
pain. We also hypothesize that patients with chronic neck pain and somatic
dysfunction exhibit more atrophy of suboccipital muscles. Lastly, because
suboccipital muscles have a high density of proprioceptors, we hypothesize
that chronic pain patients exhibit a loss in standing balance. DESIGN:
Randomized, controlled, partially blind study examining chronic neck pain
patients and control subjects for differences in degree of upper cervical
somatic dysfunction, standing balance and suboccipital muscle atrophy. SETTING: Subjects were recruited from a
clinical practice at Michigan State University; controls were recruited from
the faculty, staff and students. PARTICIPANTS:
Seven chronic neck pain patients and seven asymptomatic control subjects. MAIN OUTCOME MEASURES: Palpation was used
to diagnose somatic dysfunction in the upper cervical spine. Balance
parameters were calculated using a force platform; muscle atrophy was judged
with magnetic resonance images. RESULTS:
Chronic neck pain patients had almost twice as many somatic dysfunctions as
controls (p = .028). Force platform results showed a decrease in standing
balance in patients compared with control subjects (p = .004). MRI showed
that chronic neck pain subjects had marked atrophy of the rectus capitis
posterior major and minor muscles, including fatty infiltration. CONCLUSIONS: This study suggests that
there is a relationship between chronic pain, somatic dysfunction, muscle
atrophy and standing balance. We hypothesize a cycle initiated by chronic
somatic dysfunction, which may result in muscle atrophy, which can be further
expected to reduce proprioceptive output from atrophied muscles. The lack of
proprioceptive inhibition of nociceptors at the dorsal horn of the spinal
cord would result in chronic pain and a loss of standing balance.
|
|
Upper trapezius muscle
activity during the brachial plexus tension test in asymptomatic subjects,
Balster SM, Jull GA.
|
Man Ther. 1997
Aug;2(3):144-149.
Abstract: The brachial
plexus tension test (BPTT) is used clinically to test the dynamics of the
neural tissues of the upper quadrant. The upper trapezius muscle and the
nerves of the brachial plexus share common anatomical locations and are
jointly affected by BPTT movements. This study investigated the relationship
between the BPTT, upper trapezius muscle activity and range of neural tissue
extensibility in asymptomatic subjects. Normal male subjects with greater and
lesser neural tissue extensibility were tested. Results revealed that those
with lesser neural extensibility exhibited significantly greater upper
trapezius muscle activity during discrete BPTT stages. There was no
difference between groups in the levels of pain perceived with the test. These results suggest that asymptomatic neural
tissues are protected from stretch by muscle activity not solely mediated by
pain but also possibly mediated by stretch receptors in neural structures.
Comment: The diagnosis
and treatment of injuries to neuromuscular spindle cells, located throughout
the muscle, is a high priority in AK therapy.
|
|
Excitability changes in
human sensory and motor axons during hyperventilation and ischaemia,
Mogyoros I, Kiernan MC, Burke D, Bostock H.
|
Brain. 1997
Feb;120 ( Pt 2):317-25.
Abstract:
This study was undertaken to compare the excitability changes of
sensory and motor axons during hyperventilation and ischaemia, and to
determine why ectopic impulse activity develops more readily during
hyperventilation, and in sensory fibres. During hyperventilation for 20 min,
all six subjects reported paraesthesiae in the hand and face, and four out of
the six developed muscle twitching and cramps, associated with significant
decreases of 20-30% in the threshold current required to produce sensory and
motor potentials of constant size. During ischaemia four out of the six
subjects reported paraesthesiae, but none reported muscle twitching. There
were significant decreases of 15-20% in threshold for sensory and motor
fibres. Ischaemia produced a marked decrease in supernormality, an increase
in refractoriness and an increase in latency of the test compound sensory or
motor potential, changes that were not seen with hyperventilation. The
decrease in threshold during these manoeuvres was associated with a
significant increase in strength--duration time constant (tau SD), indicating
a relatively greater decrease in rheobase current. Using the technique of
latent addition, we found that the changes in tau SD were consistent with a
recently proposed model in which non-inactivating, voltage-dependent
'threshold channels' (presumably persistent Na+ channels) are active at
resting potential. The failure of hyperventilation to alter conduction
velocity, refractoriness or supernormality appreciably indicates that, unlike
ischaemic depolarization, hyperventilation does not increase inactivation of
conventional Na+ channels or activation of K+ channels, and this implies that
the hyperventilation-induced increase in excitability is not the result of
conventional depolarization, as seems to occur during ischaemia. These
results suggest that hyperventilation has a rather selective action on the threshold
channels, and they help to explain its greater effectiveness compared with
ischaemia in provoking ectopic discharges. The greater expression of
threshold channels in sensory than in motor fibres can explain why
hyperventilation induces paraesthesiae before fasciculation and why only
paraesthesiae occur during ischaemia.
|
|
A tension-based theory of
morphogenesis and compact wiring in the central nervous system, Van
Essen DC.
|
Nature. 1997 Jan
23;385(6614):313-8.
Abstract: Many
structural features of the mammalian central nervous system can be explained
by a morphogenetic mechanism that involves mechanical tension along axons,
dendrites and glial processes. In the cerebral cortex, for example, tension
along axons in the white matter can explain how and why the cortex folds in a
characteristic species-specific pattern. In the cerebellum, tension along
parallel fibres can explain why the cortex is highly elongated but folded
like an accordion. By keeping the aggregate length of axonal and dendritic
wiring low, tension should contribute to the compactness of neural circuitry
throughout the adult brain.
|
|
Chiropractic
Treatment of the Musculoskeletal System During Pregnancy, Bilgrai-Cohen K.
|
Journal Of The American
Chiropractic Association May 1997: 33-34, 90.
Abstract: The
childbearing year is a period of dynamic change and adaptation. Alterations
occur in every system, including the musculoskeletal system. This article
will discuss the major structural changes inherent in pregnancy, the goals of
therapy and protocol for the major presenting complaints, including
sacroiliac, lumbar and thoracic involvement Pregnancy is a time of profound
change and adaptation. As early as 10-12 weeks after fertilization, increased
estrogen and relaxin begin to affect the musculoskeletal system by causing
the softening of ligaments and increased joint laxity. Compensation for the
enlarging uterus, anteriorly, produces the need for the pregnant woman to
lean back, thus increasing the lumbar lordosis shifting the center of gravity
over the lower extremity. I point out the three joints in the ring (two SI
joints and one pubic symphysis) and explain that hormonally, one or both of
the SI joints has become softened and is less supportive than normal. The
tender muscles and joint pain is the body’s response to this instability in
the joints. A portion of my treatment of sacroiliac dysfunction occurs with
the patient in the prone position. I accomplish this by using SOT-type blocks
and pillows. Sacroiliac Involvement In the non-gravid state, the sacroiliac
(SI) joint is very stable relative to the lumbosacral joint. However, during
pregnancy, the ligamentous support to the SI joint is significantly relaxed.
This is the most common presenting musculoskeletal complaint comprising 75-85
percent of women seen during pregnancy. A portion of my treatment of
sacroiliac dysfunction occurs with the patient in the prone position. I
accomplish this by using SOT-type blocks and pillows. Lumbopelvic treatment
considerations focus on the pelvic block placement with the patient in the
prone position, sacral pumping into dural flexion on inhalation, adjust for
bilateral AS ilium, and neurolymphatic drainage particularly over the sacrum.
Thoracic techniques are also stressed in many ways during pregnancy due to
enlargement and increased weight in the breasts, widening of the sub-costal
angle and pressure on the lower four to five ribs, viscero-somatic reflex
from stressed organs such as the stomach, liver and pancreas and response to
increasing lordosis of the lumbar region.
|
|
Altered patterns of abdominal muscle activation in patients with
chronic low back pain, O'Sullivan P, Twomey L,
Allison G, Sinclair J, Miller K.
|
Aust J Physiother. 1997;43(2):91-98.
Abstract: This study investigated patterns of abdominal muscle recruitment during the abdominal drawing in manoeuvre in subjects with chronic low back pain (CLBP) and radiological diagnosis of spondylolysis or spondylolisthesis. Data were collected using surface electromyography from 12 physically active subjects with CLBP and 10 controls. The control subjects displayed an ability to preferentially activate internal oblique with minimal activation of upper rectus abdominis during the action of drawing in the abdominal wall. The group with CLBP were unable to achieve this. This finding may reflect the presence of neuromuscular dysfunction in this group. Further study is required to investigate if these findings are linked to the ability of patients with CLBP to provide dynamic stability of their lumbar spine.Comment: In this compendium of evidence for the AK approach to health care there have been over 20 studies listed demonstrating that motor control does not function properly in patients with chronic LBP and neck pain. This type of muscular dysfunction, recognized as critical in patients with LBP and neck pain, involves the disruption of the what Dr. Panjabi terms the stability system of the spine, leading to the suggestion that improper stabilization responses may serve as a perpetuating factor in patients. It would therefore be beneficial for clinicians to have at their disposal simple, reliable, and accurate tests that are capable of detecting the disturbance of these motor control responses and of monitoring the effectiveness of treatment measures designed to correct this dysfunction. AK MMT provides this type of simple, reliable, repeatable physical test. |
|
Interaction between the porcine lumbar
intervertebral disc, zygapophysial joints, and paraspinal muscles, Indahl A, Kaigle AM, Reikeras O, Holm SH.
|
Spine. 1997 Dec
15;22(24):2834-40.
STUDY
DESIGN: A porcine model was used to study whether
muscular activation in the paraspinal muscles caused by nerve stimulation in
the anulus fibrosus of a lumbar intervertebral disc could be altered by
saline injection into the zygapophysial (facet) joint. OBJECTIVES: To elucidate possible
mechanisms regarding the nerve pathways and interactions between the
intervertebral disc, zygapophysial joints, and the paraspinal musculature. SUMMARY OF BACKGROUND DATA: The
physiologic basis for chronic low back pain, including muscular spasm, is
uncertain. Although extensive research involving the lumbar motion segments
and the surrounding tissues has been performed, the neuromuscular connection
has not been sufficiently investigated. MATERIALS
AND METHODS: Twenty-three adolescent pigs were used to measure the
electromyographic response in the paraspinal musculature to electrical
stimulation of the posterolateral L3-L4 anulus fibrosus, before and after
introduction of physiologic saline into the zygapophysial joint. Motor unit
action potentials were recorded using three sets of needle electrodes placed
into the deepest fascicles of the multifidus, bilateral to the L4 and L5
spinous processes, and into the central longissimus musculature, bilateral to
the L4 spinous process. RESULTS:
Stimulation of the nerves within the posterolateral anulus of the disc
elicited reactions in the paraspinal muscles, namely the lumbar multifidus
and longissimus. Introduction of physiologic saline into the zygapophysial
joint resulted in a reduction in the motor unit action potential amplitude.
This reduction was manifested as an immediate and constant reduction, a
graded reduction, or a delayed reaction, during which the reduction occurred
an average of 5 minutes after the saline injection. CONCLUSIONS: Introduction of physiologic
saline into the zygapophysial joint reduced the stimulation pathway from the
intervertebral disc to the paraspinal musculature. The zygapophysial joints
may therefore have a regulating function, controlling the intricate
neuromuscular balance in the lumbar motion segment.
Comment: This study
shows that muscle strength changes specifically after stimulation or
irritation of the facet joints of the spine.
|
|
Mechanisms of referred visceral pain: uterine
inflammation in the adult virgin rat results in neurogenic plasma
extravasation in the skin, Wesselmann U,
Lai J.
|
Pain. 1997 Dec;73(3):309-17
Abstract: The purpose
of this study was to investigate the mechanisms of referred pain observed in
female patients with pain from the reproductive organs. We developed a model
of inflammatory uterine pain in the rat. Inflammation of the uterus in rats
pretreated with Evans Blue Dye resulted in dye extravasation in the skin over
the abdomen, groin, lower back, thighs, perineal area and proximal tail, thus
providing for the first time evidence for the trophic changes observed in the
area of referred visceral pain in an animal model of uterine pain. The
neuronal pathways mediating the observed dye extravasation in the skin after
uterine inflammation may include dichotomizing afferent fibers,
afferent-afferent interactions via a spinal cord pathway or a sympathetic
reflex. This model will allow us to gain further insight into the mechanisms
of referred pain and the trophic changes observed in the area of referred
pain in visceral disease.
Comment: A crucial
development in AK occurred when Goodheart observed that if a patient touched
an area of dysfunction, the results of MMT changed. Therapy localization has
numerous applications in AK including TL to various reflexes, subluxations,
meridian points, nerve receptors and other areas. This paper explains part of
this fascinating development in the healing arts that has been proven helpful
in the diagnosis of physical dysfunctions in patients.
|
|
Postural stability, neck proprioception and tension
neck, Koskimies K,
Sutinen P, Aalto H, Starck J, Toppila E, Hirvonen T, Kaksonen R, Ishizaki H,
Alaranta H, Pyykko I.
|
Acta
Otolaryngol Suppl. 1997;529:95-7.
Abstract: We examined
whether tension neck (TN) may due to inadequate proprioceptive and vestibular
activation of the cervico-collic reflex (CCR). CCR and vestibulospinal
responses (VSRs) were recorded from 106 forest workers by stimulating the
neck, lumbar or calf proprioceptors by vibration. The VSRs were recorded with
posturography. TN occurred in 27 out of 106 subjects. The subjects with TN
(48.5 years) were older than those without TN (43.1). The mean body sway
during quiet stance was the same in both groups during the neck stimulation.
In subjects with tension neck stimulation of neck or lumbar proprioceptors
caused excessive, unpredictable body excursion in the lateral and
anteroposterior direction that continued after stimulation. Results from
stimulation of lower limb proprioceptors did not significantly differ between
the 2 groups. In logistic regression analysis a model to predict TN
consisting of perstimulatory postural stability (odds ratio 1.4) and
poststimulatory postural stability (odds ratio 1.8) turned out to be
statistically significant. The anatomical
findings of CCR in the medulla oblongata suggest that neck muscle afferents
control the posture and muscle activity of the neck. The erroneus
facilitation of proprioception in TN subjects indicate that TN may be raised
by inadequate facilitation of CCR.
|
|
The manual muscle
examination for rotator cuff strength. An electromyographic investigation, Kelly
BT, Kadrmas WR, Speer KP.
|
Am J Sports Med. 1996
Sep-Oct;24(5):581-8.
Abstract: The
electromyographic activity of eight muscles of the rotator cuff and shoulder
girdle (supraspinatus, infraspinatus, subscapularis, pectoralis, latissimus
dorsi, and the anterior, middle, and posterior deltoid) was measured from the
nondominant shoulders of 11 subjects during a series of 29 isometric
contractions. The contractions simulated different positions used for
strength testing of the rotator cuff and involved elevation, external
rotation, and internal rotation at three degrees of initial humeral rotation
(-45 degrees of internal rotation, 0 degree, +45 degrees of external
rotation) and scapular elevation (0 degree, 45 degrees, 90 degrees).
Isolation of the supraspinatus muscle was best achieved with the test
position of elevation at 90 degrees of scapular elevation and +45 degrees
(external rotation) of humeral rotation. Isolation of the infraspinatus
muscle was best achieved with external rotation at 0 degree of scapular
elevation and -45 degrees (internal rotation) of humeral rotation. Isolation
of the subscapularis muscle was best achieved with the Gerber push-off test.
This study used four criteria for identifying the optimal manual muscle test
for each rotator cuff muscle: 1) maximal activation of the cuff muscle, 2)
minimal contribution from involved shoulder synergists, 3) minimal
provocation of pain, and 4) good test-retest reliability. Based on the
results of this study and known painful arcs of motion, an objective
identification of the optimal tests for the manual muscle testing of the cuff
was elucidated.
|
|
Normative values for isometric muscle force
measurements obtained with hand-held dynamometers, Andrews AW, Thomas MW,
Bohannon RW.
-- University of North Carolina Hospitals,
Chapel Hill, 27514, USA.
|
Phys Ther. 1996 Mar;76(3):248-59.
BACKGROUND AND PURPOSE: The extent of a patient's impairment
can be established by comparing measurements of that patient's performance
with normative values obtained from apparently unimpaired individuals. Only a
few studies have described normative values for muscle strength measured by
hand-held dynamometry. The purpose of this study of older adults, therefore,
was to obtain normative values of maximum voluntary isometric force using
hand-held dynamometers. SUBJECTS:
One hundred fifty-six asymptomatic adults (77 men, 70 women) participated in
this study. The subjects' mean age was 64.4 years (SD=8.3, range=50-79). The
male subjects' mean age was 64.5 years (SD=8.4, range=50-79), and the female
subjects' mean age was 64.3 years (SD=8.2, range=50-79). METHODS: Gender, age, dominant side,
height, weight, and activity level were recorded. Eight upper-extremity
movements (shoulder flexion, extension, abduction, and medial and lateral
rotation; elbow flexion and extension; and wrist extension) and five
lower-extremity movements (hip flexion and abduction, knee flexion and
extension, and ankle dorsiflexion) were resisted by one of three experienced
testers using a strain-gauge hand-held dynamometer. RESULTS: Gender, age, and weight were
identified as independent predictors of force for all muscle actions on both
the dominant and nondominant sides. These variables were used, therefore, to
create regression equations and normative values for the force of each muscle
action. CONCLUSION AND DISCUSSION:
The reference values provided may allow clinicians who follow the described
testing protocol to estimate the severity of force-generating impairments in
patients aged 50 to 79 years.
|
|
Inefficient muscular stabilization of the lumbar spine associated
with low back pain. A motor control evaluation of transversus abdominis, Hodges PW, Richardson CA.
|
Spine, 1996 Nov
15;21(22):2640-50.
STUDY DESIGN: The
contribution of transversus abdominis to spinal stabilization was evaluated
indirectly in people with and without low back pain using an experimental model
identifying the coordination of trunk muscles in response to a disturbances
to the spine produced by arm movement. OBJECTIVES: To evaluate the temporal
sequence of trunk muscle activity associated with arm movement, and to
determine if dysfunction of this parameter was present in patients with low
back pain. SUMMARY OF BACKGROUND DATA: Few studies have evaluated the motor
control of trunk muscles or the potential for dysfunction of this system in
patients with low back pain. Evaluation of the response of trunk muscles to
limb movement provides a suitable model to evaluate this system. Recent
evidence indicates that this evaluation should include transversus abdominis.
METHODS: While standing, 15 patients with low back pain and 15 matched
control subjects performed rapid shoulder flexion, abduction, and extension
in response to a visual stimulus. Electromyographic activity of the abdominal
muscles, lumbar multifidus, and the surface electrodes. RESULTS: Movement in
each direction resulted in contraction of trunk muscles before or shortly
after the deltoid in control subjects. The transversus abdominis was
invariably the first muscle active and was not influenced by movement
direction, supporting the hypothesized role of this muscle in spinal
stiffness generation. Contraction of
transversus abdominis was significantly delayed in patients with low back
pain with all movements. Isolated differences were noted in the
other muscles. CONCLUSIONS: The delayed
onset of contraction of transversus abdominis indicates a deficit of motor
control and is hypothesized to result in inefficient muscular stabilization
of the spine.
Comment: This study
elegantly demonstrates that sensory and motor function is integrated, and
that improper sequencing of muscle groups results in disjointed movement and
pain. AK has argued from its founding that postural control is dependent upon
the ability of the individual to properly interpret sensory information and
execute an appropriate motor response.
|
|
Multifidus muscle recovery is not automatic after resolution of
acute, first-episode low back pain, Hides JA,
Richardson CA, Jull GA.
|
Spine. 1996 Dec
1;21(23):2763-9.
STUDY
DESIGN: A clinical study was conducted on 39 patients
with acute, first-episode, unilateral low back pain and unilateral, segmental
inhibition of the multifidus muscle. Patients were allocated randomly to a
control or treatment group. OBJECTIVES:
To document the natural course of lumber multifidus recovery and to evaluate
the effectiveness of specific, localized, exercise therapy on muscle
recovery. SUMMARY OF BACKGROUND DATA: Acute
low back pain usually resolves spontaneously, but the recurrence rate is
high. Inhibition of multifidus occurs with acute, first-episode, low back
pain, and pathologic changes in this muscle have been linked with poor
outcome and recurrence of symptoms. METHODS:
Patients in group 1 received medical treatment only. Patients in group 2
received medical treatment and specific, localized, exercise therapy. Outcome
measures for both groups included 4 weekly assessments of pain, disability,
range of motion, and size of the multifidus cross-sectional area. Independent
examiners were blinded to group allocation. Patients were reassessed at a
10-week follow-up examination. RESULTS:
Multifidus muscle recovery was not spontaneous on remission of painful
symptoms in patients in group 1. Muscle recovery was more rapid and more
complete in patients in group 2 who received exercise therapy (P = 0.0001).
Other outcome measurements were similar for the two groups at the 4-week
examination. Although they resumed normal levels of activity, patients in
group 1 still had decreased multifidus muscle size at the 10-week follow-up
examination. CONCLUSIONS:
Multifidus muscle recovery is not spontaneous on remission of painful
symptoms. Lack of localized, muscle support
may be one reason for the high recurrence rate of low back pain following the
initial episode.
|
|
Responses to mechanical stimulation of the upper limb in painful
cervical radiculopathy, Hall T, Quintner J.
|
Aust J Physiother.
1996;42(4):277-285.
Abstract: Clinical and
electromyographic (EMG) responses to non-noxious mechanical stimuli were
studied in four patients with painful cervical radiculopathy, and in two
control subjects. In the symptomatic arm(s), palpation over one or more nerve
trunks was painful and accompanied by EMG activity, whereas palpation of
adjacent soft tissues was painless and unaccompanied by EMG activity.
Electromyographic activity was widespread in three patients when myotatic
reflexes were elicited in the symptomatic arm(s). In asymptomatic arms of
patients and controls, EMG responses to the myotatic reflexes were more
localised. Allodynic nerve trunks in cervical radiculopathy appear to be
afferent correlates of central sensitization; the accompanying EMG activity may represent a motor correlate of this
same process.
Comment: Muscles
throughout the area of the brachial plexus are commonly found inhibited or
atrophying after cervical spine injury and inflammation. Patients who have
experienced cervical trauma from whiplash and other dynamics often have
perplexing symptoms. This leads some doctors who do not evaluate function to
conclude that poor response to therapy is psychogenic and often related to
the patient's conscious or subconscious effort to gain in the medicolegal
process. The standard orthopedic and neurologic examination often does not
find a cause for the bizarre symptoms about which some patients complain.
Manual muscle testing is a method for evaluating the function of the nervous
system; it often reveals the cause, giving an understanding of the patient's
many complaints.
|
|
Suboccipital dermatomyotomic stimulation and digital blood flow, Purdy WR, Frank JJ, Oliver B.
|
J Am Osteopath Assoc. 1996
May;96(5):285-9.
Abstract: The effect
of gentle, soft tissue manipulation in the suboccipital region on digital
blood flow, as a measure of sympathetic nervous system activity, was studied.
Digital strain gauge plethysmography was used to measure the changes in pulse
contour during (1) a normative test period with the subject in the supine
position, (2) after a control interval (placebo) during which the
investigator placed his hands under the suboccipital region, and (3) after an
interval during which the investigator's fingers applied slow, steady,
circular kneading in the suboccipital triangle region. Twenty-five studies
were performed in a crossover design with the patient as his or her own
control. Total pulse amplitude (Y) and the height from the dicrotic notch to
the peak (X) were measured. Examination of the total data of all subjects
revealed the occurrence of a significant change in X and Y with simply
touching the suboccipital region with the hands. An even more favorable
response ensued when suboccipital manipulation was applied. Those subjects
reporting comfort or neutral responses had larger significant changes with
manipulation when compared with the group reporting the experience as
uncomfortable. The response within each group suggests that favorable
autonomic changes (sympathetic dampening) occur with specific suboccipital
manipulation as well as, indeed, the simple touching of the suboccipital
triangle.
Comment: The AK
technique called jugular decompression works specifically with the tissues of
the suboccipital triangle. Treatment to any of the 5-factors of the IVF that
improves the tone of the muscles in this area may produce the positive
effects noted in this study.
|
|
Postural stability following mild head or whiplash injuries, Rubin AM, Woolley SM, Dailey VM, Goebel JA.
|
Am J Otol. 1995
Mar;16(2):216-21.
Abstract:
Studies of the sequelae of head injury suggest that cochlear and
vestibular dysfunctions, comprise some of the most frequently reported
delayed complications following head trauma. To date, little attention has been given to the relation between
post-traumatic subjective symptoms of dizziness and the objective measures of
postural stability or balance. The purpose of this study was to
quantify the balance deficits in individuals who had developed symptoms of
dizziness following mild head and whiplash injuries. The balance abilities of
29 patients, who developed dizziness following some type of mild head or
whiplash injury, were compared to those of 51 healthy symptom-free subjects. Balance was assessed by examining the
center-of-pressure movements, in the anterior-posterior and medial-lateral
directions, and the total movement displacement. The isolated
contributions of visual and somatosensory inputs were estimated by comparing
the magnitudes of the center-of-pressure movements for the various sensory
conditions. Data were collected from three 30-second trials of each
combination of three visual conditions (accurate, absent, and inaccurate) and
two somatosensory conditions (accurate and inaccurate), with the patient standing
on a fixed-force platform. Univariate analyses of variance indicated that the
group with head injury, compared to the control group, exhibited
significantly greater anterior-posterior movements in four of the six sensory
conditions and greater total movement displacement during the inaccurate
vision/inaccurate somatosensation condition. These data suggest that patients who have sustained head or neck trauma
exhibit increased reliance on accurate visual input and are unable to utilize
vestibular orienting information to resolve conflicting information from the
visual and somatosensory systems.
Comment: Goodheart
introduced the Freeman-Wyke one-leg standing test into AK in 1989. The
patient is asked to stand upon one foot in front of the doctor, to find their
balance if they can, and then to close their eyes. If they lose their balance, the test is positive. Upon asking
the patient to therapy localize to the cervical spine, they may immediately
improve their balance. The Freeman Wyke one-leg standing test is a
functional neurological evaluation that requires the integrated function of
various proprioceptors all over the body. These complex types of challenges
are an important part of the differential diagnostic information that a
physician using AK methods can employ to determine dysfunction in the
sensory-motor-postural-proprioceptive systems in patients with post-whiplash
syndromes.
|
|
Sacroiliac
joint manipulation decreases the H-reflex, Murphy, B.A., Dawson, N.J., Slack,
J.R.
|
Electromyogr Clin Neurophysiol,
1995;35:87-94
Abstract: Joint
manipulation is widely utilized clinically to decrease pain and increase the
range of motion of joints displaying limited mobility. Evidence of efficacy
is based on subjective reports of symptom improvement as well as on the
results of clinical trials. Experiments were designed to determine whether or
not sacroiliac joint manipulation affects the amplitude of the Hoffman (H)
reflex. Surface EMG recordings of the reflex response to electrical
stimulation of the tibial nerve in the popliteal fossa were made from the
soleus muscle. The averaged amplitudes of H-reflexes were compared on both
legs before and after either sacroiliac joint manipulation or a sham
procedure. H-reflex amplitude was significantly decreased (12.9%) in the
ipsilateral leg (p < 0.001) following a sacroiliac joint manipulation
while there was no significant alteration following the sham intervention.
There was no significant alteration in reflex excitability in the
contralateral leg to the sacroiliac joint manipulation. To further
investigate the mechanism of these reflex alterations, the local anesthetic
cream EMLA (Astra Pharmaceuticals) was applied to the skin overlying the
sacroiliac joint and the experiments were repeated on a different group of
subjects. This was intended to determine if excitation of cutaneous afferents
was responsible for the reflex excitability changes. There was still a
significant decrease in reflex excitability (10.6%) following sacroiliac
joint manipulation (p < 0.001). These findings indicate that joint
manipulation exerts physiological effects on the central nervous system,
probably at the segmental level. The fact that the changes persisted in the
presence of cutaneous anesthesia suggests that the reflex changes are likely to
be mediated by joint and/or muscle afferents.
Comment: This study
offers further elucidation of the finding of the physiological response of
muscles to sacroiliac manipulation. One basic physiologic response to spinal
manipulative therapy is a transient decrease or increase in motoneuron
activity as assessed by the Hoffmann reflex (H-reflex) technique, depending
upon the patients neuromuscular status at the time of measurement. The
H-reflex technique involves peripheral stimulation of the Ia-afferent feedback
pathway to assess the excitability of the alpha motoneuron. The MMT in AK
evaluates the same neurological mechanism. This study shows that the clinical
efficacy of SMT may involve a change in motoneuron activity which, in turn,
may lead to a reduction in hypertonic as well as an increase in hypotonic
muscles. Thus, a basic neurophysiologic response to SMT is muscular response
to treatment.
|
|
Flexion-relaxation phenomenon in the back muscles. A
comparative study between healthy subjects and patients with chronic low back
pain, Shirado O, Ito T,
Kaneda K, Strax TE.
|
Am J
Phys Med Rehabil. 1995 Mar-Apr;74(2):139-44.
Abstract: At a certain
position of trunk flexion, there is a sudden onset of electrical silence in
back muscles. This is called "flexion-relaxation (F-R) phenomenon."
The goals of this study were (1) to evaluate the relationship between flexion
angle and activity of back muscles during flexion movement and (2) to
determine what the difference is between healthy subjects and patients with
chronic low back pain (CLBP). Twenty-five healthy subjects (13 males and 12
females; average age, 28.3 yr) and 20 patients with CLBP (12 males and 8
females; average age, 34.1 yr) volunteered for this study. The subjects were
asked to flex forward maximally from the erect position and to maintain full
flexion, followed by returning to the initial upright position. Flexion angle
of trunk and hip was measured during the examination. Electromyographic
activity of erector spinae was also monitored simultaneously. F-R phenomenon
was observed in all healthy subjects before reaching the maximum flexion.
Electrical silence continued even after extending the trunk began. In
contrast, no patients with CLBP demonstrated F-R phenomenon. A significant
difference in muscular activities of erector spinae between the groups was
obtained when returning to the erect position from the maximum flexion.
Moreover, time lag between trunk and hip movement was much greater in
patients than in healthy subjects. This
study demonstrated that neuromuscular coordination between trunk and hip
could be abnormal in patients with CLBP.
Comment: The key
technical factor in the examination of patients with CLBP would be the MMT
that makes the detection of the muscular imbalances and aberrant muscular activation
patterns cited in this paper identifiable.
|
|
Changes in neck electromyography associated with meningeal noxious
stimulation, Hu JW, Vernon H, Tatourian I.
|
J Manipulative Physiol Ther. 1995
Nov-Dec;18(9):577-81.
OBJECTIVE: To determine
if the activity of jaw and neck muscles in a rat model is influenced by the
application of small-fiber irritant mustard oil to meningeal/dural vascular
tissues. DESIGN: Controlled
animal experiment. SETTING:
University neurophysiology laboratory. INTERVENTIONS:
Applications of mineral oil (vehicle control) and mustard oil to exposed
meningeal/dural vascular tissues. MAIN
OUTCOME MEASURE: Electromyographic (EMG) recordings from deep
suboccipital muscles, bilaterally, and the left trapezius and left masseter
muscles. RESULTS: Mineral oil
evoked no EMG responses in any muscles. The incidences of mustard oil-evoked
EMG increases were 100%, 100%, 89% and 78% for left deep neck, right deep
neck, left trapezium and left masseter muscles, respectively. The durations
of EMG responses were (mean +/- SD) 19.2 +/- 6.6 min, 17.3 +/- 7.5 min, 14.5
+/- 6.8 min and 12.7 +/- 8.5 min, respectively. CONCLUSIONS: These results document that meningeal/dural
vascular irritation leads to sustained and reversible activation of neck and
jaw muscles that may be related to the clinical occurrence of muscular
tension and pain associated with certain types of headaches, particularly
migraine.
|
|
The influence of afferent inputs from skin and
viscera on the activity of the bladder and the skeletal muscle surrounding
the urethra in the rat, Morrison
JF, Sato A, Sato Y, Yamanishi T.
|
Neurosci
Res. 1995 Sep;23(2):195-205
(1) Somato-visceral and
viscero-visceral reflex interactions have been studied in the bladder
branches of the pelvic nerve and in the electromyographic (EMG) activity of
the periurethral skeletal muscles of the anesthetized rat, and by
observations of changes in bladder motility. (2) Slow distensions of the
bladder caused some elevation of intravesical pressure, and culminated in a
micturition contraction. Periurethral EMG activity increased gradually during
the bladder distension, and showed an oscillatory marked increase during the
bladder contraction. There was a small increase in pelvic nerve efferent
activity during slow distension, and there was a substantial increase before,
or at the start, of a micturition contraction. (3) Oscillatory bursting
activity occurred in recordings of the EMG activity from periurethral
skeletal muscle during the rising phase of micturition contraction; this was
particularly so during the most rapid rise in intravesical pressure, and
periods of electrical silence lasting 80-270 ms alternated with bursts of
activity in the periurethral EMG. (4) In the present experiments, the
switching mechanism activated by pelvic afferent signals related to
intravesical pressure reversed the behavior of a number of reflex pathways. When the bladder pressure was low, nociceptive
pinching of the perineal skin usually caused bladder contraction and a rise
in pelvic nerve efferent activity and in periurethral EMG activity.
When the bladder was full, micturition contractions were present and reduced
in size and frequency by pinching of the perineal skin. The pelvic nerve
efferent activity was correspondingly reduced, while the EMG activity
increased during and following the nociceptive stimulus. Cooling the scrotal
skin with ice also decreased the frequency of bladder contractions. (5) When
the bladder pressure was low, distension of the anus and colon increased
periurethral EMG activity, but did not affect bladder tone. However, when the
bladder was full, these stimuli reduced the size and frequency of bladder
contractions, associated with a reduction in the pelvic nerve efferent
activity. There was usually a simultaneous reduction in the EMG activity in
periurethral muscles. Similar results were obtained during distension of the
seminal vesicles or vagina, or following injection of 20-60 microliters of
saline into the lumen of the vas deferens. Reversal of the responses at
extremes of intravesical pressure was observed in every case. (6) Following
spinal transection at the upper cervical or thoracic level, micturition
contractions were absent at high bladder volumes. However the effects
described when the neuraxis was intact and the bladder pressure was low were
still observed.
Comment: A crucial
development in AK occurred when Goodheart observed that if a patient touched
an area of dysfunction, the results of MMT changed. Therapy localization has
numerous applications in AK including TL to various reflexes, subluxations,
meridian points, nerve receptors and other areas. This paper explains part of
this fascinating development in the healing arts that has been proven helpful
in the diagnosis of physical dysfunctions in patients.
|
|
The role of the psoas and iliacus muscles for
stability and movement of the lumbar spine, pelvis and hip, Andersson E,
Oddsson L, Grundstrom H, Thorstensson A.
|
Scand J
Med Sci Sports. 1995 Feb;5(1):10-6
Abstract: The
activation patterns of the psoas and iliacus muscles were investigated in 7
healthy adult subjects (4 men and 3 women) during a variety of motor tasks in
standing, sitting and lying. Myoelectric activity was recorded simultaneously
from the 2 muscles using thin wire electrodes inserted under guidance of
high-resolution ultrasound. In general, both muscles were coactivated, albeit
to different relative levels, particularly when hip flexor torque was
required. Selective activation of the iliacus could, however, be seen to
stabilize the pelvis in contralateral hip extension during standing. Psoas
was found to be selectively involved in sitting with a straight back and in
contralateral loading situations requiring stabilization of the spine in the
frontal plane. During training exercises from a supine position, such as
sit-ups, the contribution of the psoas and iliacus muscles could be varied by
changing the range of motion as well as the position and support for the
legs. Thus, the 2 anatomically different muscles of the iliopsoas complex
were shown to have individual and task-specific activation patterns depending
on the particular demands for stability and movement at the lumbar spine,
pelvis and hip.
|
|
Shoulder weakness in professional baseball pitchers,
Magnusson SP, Gleim GW, Nicholas JA.
|
Med Sci
Sports Exerc. 1994 Jan;26(1):5-9.
Abstract: The purposes
of this study were to: 1) compare shoulder range of motion and strength in
professional baseball pitchers (N = 47) compared with age-matched controls (N
= 16), and 2) examine the relationship of injury history to strength and
range of motion. Based on injury history pitchers were categorized as: 1)
none (N = 26), 2) injury requiring conservative intervention (N = 9), or 3)
injury requiring surgical intervention (N = 12). Range of motion was measured
for internal rotation (IROM) and external rotation (EROM). Eccentric strength
was measured by hand-held dynamometer for internal rotation (IR), external
rotation (ER), abduction (ABD), and supraspinatus muscle (SUP) strength.
Injury history had no effect on strength and range of motion. Dominant EROM
was greater in pitchers, P < 0.0001, and controls, P < 0.05, with
pitchers having greater EROM motion bilaterally, P < 0.0001. Pitchers were weaker in SUP on the dominant vs
nondominant side, P < 0.0001, and on the dominant side for weight adjusted
ER, ABD, P < 0.01, and SUP, P < 0.0001, compared with controls.
In conclusion, dominance and pitching
resulted in soft tissue adaptation. Pitchers displayed weakness in three of
four tests by comparison with controls, suggesting that the demands of
pitching are insufficient to produce eccentric strength gains and may in fact
lead to weakness. Dominant-side SUP weakness in pitchers may reflect
subclinical pathology or chronic fatigue.
|
|
Thermal deficit in lumbar radiculopathy. Correlations with pain and
neurologic signs and its value for assessing symptomatic severity, Takahashi Y, Takahashi K, Moriya H.
|
Spine. 1994 Nov 1;19(21):2443-9;
discussion 2449-50.
STUDY DESIGN. The
relationship between areas of thermal deficit and areas exhibiting other
symptoms and neurologic signs, and the significance of the magnitude of
thermal deficit in lumbar radiculopathy were analyzed. OBJECTIVES. To determine the clinical
significance and value of thermal deficit as a sign of lumbar radiculopathy. SUMMARY OF BACKGROUND DATA. Thermal deficit
has been discussed as a factor in the diagnosis of involved nerve roots.
However, it has not been previously correlated with any particular symptoms
or signs. METHODS. Sixty-eight
healthy subjects and one hundred nine patients with lumbar radiculopathy due
to intervertebral disc herniation underwent thermography. Sensitivity,
specificity, and the agreement rate of thermal deficit to symptoms and
neurologic signs were calculated in ten body regions. Total temperature
difference of the affected limb was compared with the Japanese Orthopaedic
Association scoring system. RESULTS.
The agreement rates of thermal deficit with pain, muscle tenderness, motor weakness, and sensory disturbance
were 60.9, 69.3, 71.8, and
71.8%, respectively. Sensitivity and specificity of thermal deficit to
symptoms and signs were approximately 30% and 80%, respectively. The
correlation coefficient of temperature decrease of the affected limb and the
Japanese Orthopaedic Association score was 0.57, indicating a moderate
correlation. CONCLUSIONS.
Thermal deficit should be considered an independent sign of lumbar
radiculopathy. The relatively high specificity suggests that a normal
temperature may indicate an asymptomatic region. Symptomatic severity of
lumbar radiculopathy may be assessed by measuring the magnitude of thermal
deficit in the affected limb.
Comment: The
correspondence between thermal deficit and motor weakness was the highest
correlation cited in this study, indicating that measuring motor weakness in
the affected limb may also assess the severity of lumbar radiculopathy. This
study showed that disturbances of muscle function change skin temperature
readings also.
|
|
The role of
sensory information in the guidance of voluntary movement, McCloskey, D.I.,
Prochazka, A.
|
Somatosensory and Motor Research,
1994;11:69-76
Abstract: For voluntary
movements to be well timed and accurate, they require coordinated tactile,
visual and proprioceptive information about the movement in progress.
Locomotion should be a stable cycle generated by the sensory links between
the musculoskeletal system, the neural system and the environment.
|
|
Cervical musculoskeletal dysfunction in post-concussional headache, Treleaven J, Jull G, Atkinson L.
|
Cephalalgia,
1994 Aug;14(4):273-9; discussion 257.
Abstract: Persistent
headache is a common symptom following a minor head injury or concussion,
possibly related to simultaneous injury of structures of the cervical spine.
This study measured aspects of cervical musculoskeletal function in a group
of patients (12) with post-concussional headache (PCH) and in a normal
control group. The PCH group was
distinguished from the control group by the presence of painful upper
cervical segmental joint dysfunction, less endurance in the neck flexor
muscles and a higher incidence of moderately tight neck musculature.
Active range of cervical motion and postural attitude were not significantly
different between groups. As upper cervical joint dysfunction is a feature of
cervicogenic causes of headache, the results of this study support the
inclusion of a precise physical examination of the cervical region in
differential diagnosis of patients suffering persistent headache following
concussion.
Comment: The need for
specific and reliable clinical tests for cervical muscular function is
highlighted in this paper. Tests that are cost-effective and reliable provide
the practitioner with a powerful tool for initial examination, and for
repeated tests to measure the effectiveness of treatment. The complexity of
injury in PCH is such that a system of diagnosis and treatment has been
developed in AK that encompasses a wide range of modalities.
|
|
Isokinetic Muscle Testing:
Is It Clinically Useful?, Almekinders LC, Oman J.
|
J Am Acad Orthop Surg, 1994 Jul;2(4):221-225.
Abstract: The use of
computer-driven muscle-testing devices has become increasingly popular during
the past two decades. This expensive equipment allows evaluation of muscles
and muscle groups in an isokinetic manner. Isokinetic muscle testing is
performed with a constant speed of angular motion but variable resistance.
Isokinetic dynamometers have been shown to produce relatively reliable data
when testing simple, uniaxial joints, such as the knee, as well as when
testing the spine in flexion and extension. Isokinetic strength data are
generally not helpful in the diagnosis of orthopedic abnormalities.
Isokinetic testing can be helpful during the rehabilitation of orthopedic
patients, since it allows easy monitoring of progress. It also enables the
patient to work on muscle rehabilitation in a controlled manner at higher
speeds than are possible with more conventional exercise equipment. An
isokinetic rehabilitation program can be easily tailored with concentric and
eccentric components that closely resemble muscle actions during occupational
and sports activities.
|
|
Arthrogenic quadriceps
inhibition and rehabilitation of patients with extensive traumatic knee
injuries, Hurley M, Jones D, Newham D
|
Clin Sci (Lond).1994
Mar;86(3):305-10.
Abstract: 1. The
relationship between joint damage, quadriceps weakness and arthrogenic muscle
inhibition was investigated in eight patients who had sustained extensive
traumatic knee injury. Isometric and isokinetic quadriceps and hamstring
voluntary strength, and quadriceps arthrogenic muscle inhibition during
isometric contractions, were measured before and after 4 weeks (approximately
100 h) of intensive rehabilitation. 2. Compared with the uninjured leg,
before rehabilitation the injured leg had larger amounts of quadriceps
arthrogenic muscle inhibition (P < 0.025), quadriceps (P < 0.0001) and
hamstring (P < 0.0001) weakness and severe functional joint instability.
There was a negative correlation between the amount of arthrogenic muscle
inhibition and quadriceps voluntary contraction force (P < 0.025). 3.
After rehabilitation in the injured leg there were small hamstring strength
increases (P < 0.05-0.025), but no overall significant quadriceps strength
increase. Arthrogenic muscle inhibition was statistically unchanged. Severe
functional joint instability was still reported by all patients. 4. Previous
studies have shown that minimal joint damage evokes relatively less
arthrogenic muscle inhibition that does not impede rehabilitation. These data
indicate that greater joint damage is associated with greater arthrogenic
muscle inhibition, quadriceps weakness and joint instability. Furthermore,
intensive rehabilitation had little affect on either quadriceps arthrogenic
muscle inhibition or atrophy.
Comment: This study
indicates that specific injuries to the knee joint produce measurable
inhibitions of quadriceps and hamstring muscles. This is a central tenet of
AK, i.e. that joint injuries will produce muscle weakness that can be
specifically diagnosed and treated. On a clinical basis, AK physicians find
this consistently when testing patients with knee injuries. The fact that
rehabilitation did not improve the arthrogenic inhibition found in these
patients may indicate that the totality of their joint and muscle problems in
the knee was not adequately treated.
|
|
Atrophy of suboccipital
muscles in patients with chronic pain: a pilot study, Hallgren RC,
Greenman PE. Rechtien JJ.
|
J Am Osteopath Assoc.
1994 Dec;94(12):1032-8.
Abstract:
Magnetic resonance imaging studies were performed in six patients
with chronic head and neck pain and in five control subjects to determine
whether irreversible atrophic changes resulting in destruction of muscle
fibers have a role in patients with chronic pain specific to the cervical
spine. Both groups of subjects had medical history obtained and underwent
physical examination and proton density-weighted (PD-weighted) magnetic
resonance imaging. Subjects with chronic pain had substantial restriction of
motion. Axial proton density-weighted images of the rectus capitis major and
minor muscles were examined. In the subjects with chronic pain, the muscles
had high signal intensity, indicating replacement of dead suboccipital
skeletal muscle with fatty tissue. This infiltration was not observed in the
control subjects who were free of significant motion restrictions and had no
history of recurring neck and head pain. Analysis of pixel intensity values
confirmed this finding. The reduction in proprioceptive afferent activity in affected
muscles may cause increased facilitation of neural activity that is perceived
as pain. At least mean squares algorithm was used to define a linear
estimating equation for each subject. Linear regression analysis, using an
alpha level < .005, was used to determine how well each subject's data fit
the estimating equation. This preliminary work indicates substantial
infiltration of fatty tissue into suboccipital muscles of some subjects being
treated for chronic head and neck pain.
|
|
Evidence of lumbar multifidus
muscle wasting ipsilateral to symptoms in patients with acute/subacute low
back pain, Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH.
|
Spine. 1994 Jan
15;19(2):165-72.
Abstract:
The effect of low back pain on the size of the lumbar multifidus muscle
was examined using real-time ultrasound imaging. Bilateral scans were
performed in 26 patients with acute unilateral low back pain (LBP) symptoms
(aged 17-46 years) and 51 normal subjects (aged 19-32 years). In all
patients, multifidus cross-sectional area (CSA) was measured from the 2nd to
the 5th lumbar vertebrae (L2-5) and in six patients, that of S1 was also
measured. In all normal subjects, CSA was measured at L4 and in 10 subjects
measurements were made from L2-5. Marked asymmetry of multifidus CSA was seen
in patients with the smaller muscle being on the side ipsilateral to symptoms
(between-side difference 31 +/- 8%), but this was confined to one vertebral
level. Above and below this level of wasting, mean CSA differences were <
6%. In normal subjects, the mean differences were < 5% at all vertebral
levels. The site of wasting in patients corresponded to the clinically
determined level of symptoms in 24 of the 26 patients, but there was no
correlation between the degree of asymmetry and severity of symptoms.
Patients had rounder muscles than normal subjects (measured by a shape ratio
index), perhaps indicating muscle spasm. Linear measurements of multifidus
cross-section were highly correlated with CSA in normal muscles but less so
in wasted muscles, so CSA measurements are more accurate than linear
dimensions. The fact that reduced CSA, i.e., wasting, was unilateral and
isolated to one level suggests that the mechanism of wasting was not
generalized disuse atrophy or spinal reflex inhibition.
Comment: The
researchers in this paper have found lumbar multifidus muscle atrophy occurs
in patients with low back pain. In this study, no therapy for this finding
was offered, and the functional state of these muscles was not evaluated.
Were the muscles neurologically inhibited or facilitated; were they capable
to functioning better? AK
has presented the new principle that the scientific literature had not
previously dealt with; the correct form of manual treatment can instantly
improve muscle function.
|
|
The influence of ankle
sprain injury on muscle activation during hip extension, Bullock-Saxton
JE, Janda V, Bullock MI.
|
Int J Sports Med. 1994
Aug;15(6):330-4.
Abstract:
The likely influence of a localized injury in a distal joint on the function
of proximal muscles is an important consideration in assessment and treatment
of musculoskeletal injuries. However, little
experimental evidence in humans exists in this area. Accordingly, a
controlled study was carried out, in which the function of muscles at the hip
was compared between subjects who had suffered previous severe unilateral
ankle sprain and matched control subjects. The pattern of activation of the
gluteus maximus, the hamstring muscles and the ipsilateral and contralateral
erector spinae muscles was monitored through the use of surface
electromyography during hip extension from prone lying. Analyses revealed that the pattern of muscle
activation in subjects with previous injury differed markedly from normal control subjects,
and that changes appeared to occur on both the uninjured and the injured
sides of the body. A significant difference between the two groups was the
delay in onset of activation of the gluteus maximus in previously injured
subjects. The existence of remote changes
in muscle function following injury found in this study emphasise the
importance of extending assessment beyond the side and site of injury.
|
|
Various
Forms of Chiropractic Technique, Bergmann, T.
|
Chiropractic Technique, May 1993;
5(2):53-5.
Doctors who noticed a regularity in their results and began to ask why those results occurred started the majority of chiropractic technique systems. The apparent fallacy to many of these system approaches is that the evaluative procedure linked to the manipulative procedure is often singular and very simplistic. The human body; however, is a very complex and integrative organism, and to rely on a single evaluative tool for the sole application of a therapeutic intervention should not be considered sound clinical practice. It has not been established that any adjective or evaluative procedure is more or less effective than any other for any condition. Studies comparing the effectiveness and efficiency of technique systems are long over due. |
|
Neuromuscular
effects of temporomandibular joint dysfunction, Esposito, V., Leisman G,
Frankenthal Y.
|
Intern J Neuroscience, 1993;68
Abstract:
Neurologically intact male and female TMJ dysfunction patients with
or without cervical spine involvement were examined using standard clinical
neurologic testing for balance and coordination. Seventy percent of the TMJ
patients without cervical involvement exhibited positive signs for balance,
coordination, and/or ataxia found in response to having the patient’s
mandible stressed by extending it a far as possible laterally, and also
opened (as wide as possible) or closed (biting down). The performance of
patients with cervical involvement was not significantly different than those
without cervical involvement. Further examination of the relation between the
TMJ and auditory, visual, cerebellar, and coordination mechanisms is
therefore indicated.
|
|
Cervical headache: an investigation of natural head posture and upper
cervical flexor muscle performance, Watson DH, Trott
PH
|
Cephalalgia,
1993 Aug;13(4):272-84; discussion 232.
Abstract: In this
study, 60 female subjects, aged between 25 and 40 years, were divided into
two equal groups on the basis of absence or presence of headache. A passive
accessory intervertebral mobility (PAIVM) examination was performed to confirm
an upper cervical articular cause of the subjects' headache and a
questionnaire was used to establish a profile of the headache population.
Measurements of cranio-cervical posture and isometric strength and endurance
of the upper cervical flexor muscles were compared between the two groups of
subjects. The headache group was found to
be significantly different from the non-headache group in respect to forward
head posture (FHP) (t = -5.98, p < 0.00005), less isometric strength (t =
3.43, p < 0.001) and less endurance (t = 8.71, p < 0.0005) of the upper
cervical flexors. A
statistically significant relationship was also established between natural
head posture and isometric endurance of the upper cervical flexor musculature
which demonstrated that FHP corresponded with a low endurance capacity (chi 2
= 13.2; p < 0.01). The outcome of this study highlights the
need to screen for cervical etiology in patients who are suspected of
suffering from common migraine.
|
|
The influence of arthrogenous muscle inhibition on quadriceps
rehabilitation of patients with early, unilateral osteoarthritic knees, Hurley MV, Newham DJ.
|
Br J Rheumatol,
1993 Feb;32(2):127-31.
Abstract:
Reflex arthrogenous muscle inhibition (AMI) may cause muscle atrophy
or impede effective rehabilitation of affected muscle groups. To investigate
this, bilateral quadriceps AMI, isometric and isokinetic muscle strength were
measured in 10 patients with unilateral osteoarthritic knees, before and
after a course of routine physiotherapy. Before rehabilitation, quadriceps of
all the diseased legs were inhibited (P < 0.05) and 40% weaker (P <
0.02) than the non-diseased legs. Following rehabilitation, AMI decreased (P
< 0.01) in the diseased leg and strength increased at all test velocities
(P < 0.05-0.005); however, strength deficits compared with the
non-diseased leg remained. Subjective improvements in functional ability and
confidence in the diseased leg were reported. Though AMI may be partially
responsible for unilateral muscle weakness, it does not preclude strength
gain in affected muscles. Possible physiological mechanisms which evoke AMI
may also adversely affect muscle proprioception, implicating AMI as a
possible cause of initiation or progression of degenerative joint disease.
Comment: This study
demonstrates that being able to reduce arthrogenous muscle inhibition in
patients recovering from joint injuries is important to the rehabilitation
process. It also shows that a measurable change in muscle strength, from
inhibition to strength, occurs after manipulative therapy. AMI is the
inability of a muscle to recruit all motor units of a muscle group during a
maximal effort voluntary muscle contraction and it is a natural response
designed to protect joints from further damage. The AMI phenomenon is frequently
found during AK evaluations when there is muscle weakness around joints that
have been injured. Mechanoreceptor activity plays a primary role in AMI.
Manipulation of a joint has been shown to activate mechanoreceptors from
structures in and around the manipulated joint. The altered afferent input
arising from the stimulation of these receptors is thought to cause changes
in motor neuron excitability, with a
subsequent decrease in AMI. This is assumed to influence motor
neuron pool recruitment during voluntary muscle contraction.
|
|
Reflex activation of gluteal muscles in walking. An approach to
restoration of muscle function for patients with low-back pain, Bullock-Saxton JE, Janda V, Bullock MI.
|
Spine, 1993
May;18(6):704-8.
Abstract: Gluteal
activation and pelvic stability often are decreased in chronic low-back pain
sufferers, but the importance of motor control and programming in treatment
has not been fully evaluated. This study investigated whether gluteal muscles
could be activated more effectively by stimulating the proprioceptive
mechanism during walking. Labile support, through wearing "balance
shoes," offered facilitation of cerebellovestibular circuits.
Electromyographic recordings of gluteus maximus and medius in 15 healthy subjects
were made during barefoot and balance shoes walking before and after 1 week
of facilitation. Significant increases (P < 0.0002) in gluteal activity
and significant decreases (P < 0.01) in time to 75% maximum contraction,
demonstrated the value of sensorimotor elicitation of subconscious and
automatic responses in muscles often weakened in back pain sufferers.
Comment: AK adds a
dynamic aspect to orthopedic examination as it relates to the extremities.
Knowledge of predictable muscle function resulting from stimulating the foot
proprioceptors (the object of this study) helps understand how subluxations
and muscle dysfunction of the feet affect remote areas of the body.
|
|
Childhood psychological trauma and chronic refractory low-back pain, Schofferman J, Anderson D, Hines R, Smith G, Keane G.
|
Clin J Pain. 1993
Dec;9(4):260-5.
OBJECTIVE: To examine
the correlation between childhood psychological trauma(s) and refractory back
pain in patients with and patients without prior spine surgery. DESIGN: Retrospective chart review survey
of 101 consecutive patients who had undergone multidisciplinary evaluation
for refractory back pain. SETTING:
Private practice, tertiary care spine center. MAIN OUTCOME MEASURES: Each psychological risk factor
(physical abuse, sexual abuse, emotional neglect or abuse, abandonment, and
chemically dependent caregiver) was rated as present or absent. Spinal
pathology was graded as significant or not significant. RESULTS: There were 56 patients with
failed back surgery syndrome, 28 men and 28 women, with a mean age of 43 and
mean pain duration of 45 months. There were 45 patients with no prior
surgery, 26 men and 19 women, with a mean age of 43 and mean pain duration of
33 months. In the failed back surgery syndrome group, 27 (48%) had three or
more risks and 39 (70%) had two or more. When the 12 patients with
significant pathology are not considered, 24 of the remaining 44 (55%)
patients had three or more risks. In the group with no prior surgery, 26
(58%) had three or more risks and 38 (84%) had two or more. When the five
patients with significant pathology are not considered, 24 (60%) had three or
more risks. CONCLUSIONS:
Multiple childhood psychological traumas may predispose a person to chronic
low back pain. In patients in this setting with refractory low back pain with
or without prior lumbar spine surgery, three or more childhood psychological
risk factors are prevalent, especially in patients with minimal structural
pathology.
|
|
Chronic musculoskeletal pain and depressive symptoms in the National
Health and Nutrition Examination. I. Epidemiologic follow-up study, Magni G, Marchetti M, Moreschi C, Merskey H, Luchini SR.
|
Pain. 1993
May;53(2):163-8.
Abstract:
We report here follow-up data on subjects who were examined in two
surveys conducted by the United States Center for Health Statistics at an
interval of 8 years. The first survey was the 1st National Health and
Nutrition Examination Survey (NHANES-1), and the second conducted 8 years
later was the National Health and Nutrition Epidemiologic Follow-up Study
(NHEFS). From an original sample of 3023 subjects, 153 were known to be
deceased, leaving a potential sample of 2870 cases, of whom 2341 were
ultimately examined in the NHEFS. The definition of pain used in the NHANES-1
survey identified 15% of the subjects as suffering from persistent pain.
Using a different pain definition, in the NHEFS, the frequency of subjects
with chronic pain was 32.8%. Applying this second definition, the percentage
of subjects with chronic pain in the NHANES-1 had risen from 15 to 20.2. Some
subjects (32.5%) who originally had chronic pain were free from pain at the
time of follow-up; 59% of the subjects with chronic pain on follow-up did not
have it initially. As found originally in the NHANES-1, the group with chronic
pain at the NHEFS comprised significantly more females, older people, and
people with lower income. On logistic
regression analysis the strongest relationship found at the NHEFS between the
variables examined was between chronic pain and depression.
Comment: In AK
examination it is frequently found that many mental and emotional problems
are due to physiological dysfunction. This paper highlights the fact that
depression and other psychological concomitants to spinal pain may be
resolved with successful chiropractic treatment to the patient’s pain
syndromes.
|
|
Cervical spine subluxation associated with congenital muscular
torticollis and craniofacial asymmetry, Slate RK,
Posnick JC, Armstrong DC, Buncic JR.
|
Plast Reconstr Surg.
1993 Jun;91(7):1187-95; discussion 1196-7.
Abstract: The
relationship between craniofacial asymmetry, congenital muscular torticollis,
and cervical spine subluxation was examined in a study of 30 children who
presented to our Craniofacial Program from 1987 through 1990. Twenty-six of the
30 patients had craniofacial asymmetry and muscular torticollis without true
suture synostosis documented by head and neck CT scans. These 26 patients had
positional skull molding with consistent flattening of the contralateral
occipitoparietal region and the ipsilateral fronto-orbital region relative to
the side of the torticollis. Thirteen of the 26 patients also were found to
have a C1-C2 subluxation. C1 was rotated forward of C2 on the side
contralateral to the muscular torticollis in 12 of 13 patients. None of the
patients with subluxation had neurologic deficits or required spinal
stabilization. Ophthalmologic evaluations demonstrated amblyopia (4 patients)
and horizontal strabismus (1 patient), both thought to be coincidental, with
no evidence of nystagmus in any case. Seven of the 26 patients required
surgical therapy for their neck muscle tightness, while the remainder
responded to physiotherapy. Only 2 of the 26 patients underwent
cranio-orbital reshaping for correction of their upper face asymmetry.
Recognition of cervical subluxation in patients with congenital muscular
torticollis may help to explain residual head-neck posturing problems even
after successful neck muscle therapy.
|
|
The lumbar multifidus muscle five years after
surgery for a lumbar intervertebral disc herniation, Rantanen J, Hurme M, Falck B, Alaranta H,
Nykvist F, Lehto M, Einola S, Kalimo H.
|
Spine. 1993 Apr;18(5):568-74.
Abstract: Biopsy
specimens of the lumbar multifidus were obtained from 18 patients with lumbar
disc herniation at operation and after a postoperative follow-up period of 5
years. The structure and morphometry of the muscle fibers were analyzed and
these data were compared with intraoperative biopsy results and the clinical
outcome of the operation. The main findings were: 1) on the basis of
occupational handicap score 10 patients belonged in the "positive"
and 8 in the "negative" outcome group; 2) the intraoperatively
recorded selective type 2 muscle fiber atrophy and the extent of pathologic
inner structure changes both decreased in the "positive" outcome
group, whereas they persisted in the "negative" group; 3) grouping
as a definite sign of reinnervation was seen in only two versus four patients
of the "positive" versus "negative" outcome group; 4) the
relative amount of adipose tissue within the muscle decreased more markedly
in the "positive" outcome group. The authors propose that both
inactivity and axonal injury (mainly of neurapraxia type) contribute to the
selective type 2 atrophy and inner structure changes in disc patients'
multifidus muscle. These pathologic
structural changes correlated well with the clinical outcome, and most
importantly they are reversible and can be diminished by adequate therapy.
|
|
The effects of neutral posture deviations on perceived
joint discomfort ratings in sitting and standing postures, Genaidy AM, Karwowski W.
|
Ergonomics. 1993 Jul;36(7):785-92.
Abstract: There is a
pressing need to rank body deviations from neutral postures which occur due
to variety of body movements around different joints. Such knowledge is
needed to better understand potentially adverse effects of poor working
postures on the industrial population. The main objective of this study was
to examine the effects of postural deviations on perceived joint discomfort
ratings assessed under similar working conditions. Twelve males and seven
females participated in the laboratory study. The results revealed several
distinct classes of joint deviations from neutral postures, which need to be
assigned different weights of postural stress. A preliminary ranking system
for assessment of stressfulness of human body deviations about different
joints was proposed.
Comment: Postural
analysis is a major source of information in AK. It is one of several methods
for locating probable muscle dysfunction. As one becomes more familiar with
AK, nearly all postural imbalances can be readily understood as a result of
aberrant muscle function in nearly all cases.
|
|
The reflex
effects of spinal somatic nerve stimulation on viscera function, Sato, A.
|
J Manipulative Physiol Ther, 1992;15(1):57-61
Abstract: This paper
studies somatovisceral reflex responses in the cardiovascular organ,
gastrointestinal tract, urinary bladder and adrenal medulla in anesthetized
animals after eliminating emotional factors following somatic sensory
stimulations. Various somatic sensory stimulations, including cutaneous,
muscle and articular sensory stimulations, can produce differing autonomic
reflex responses, depending on which visceral organs and somatic afferents
are stimulated. Some responses have dominant sympathetic efferent
involvement, whereas others have dominant parasympathetic efferent
involvement. Some responses have propriospinal and segmental characteristics,
while others have supraspinal and generalized characteristics in their reflex
nature. These somatovisceral reflex responses may be functioning during
spinal manipulative therapy in conscious humans.
|
|
Evaluation of neck muscle strength with a
modified sphygmomanometer dynamometer: reliability and validity, Vernon HT,
Aker P, Aramenko M, Battershill D, Alepin A, Penner T.
-- Canadian Memorial Chiropractic College,
Toronto, Ontario.
|
J Manipulative Physiol Ther. 1992 Jul-Aug;15(6):343-9.
OBJECTIVE: Determine test-retest reliability, normative
data and clinical validity of isometric muscle strength testing in the neck
with a modified sphygmomanometer dynamometer (MSD). DESIGN: Analytic survey. Paired trials of
various muscle strength tests were conducted on convenience samples of normal
subjects and consecutive samples of symptomatic subjects. SETTING: Outpatient chiropractic research
clinic. PATIENTS/SUBJECTS: For
study 2, 40 normal male subjects, average age 25 +/- 2 yr, were studied for
reliability and normative data. For study 3, 24 symptomatic patients, 12
males and 12 females, average age 39 +/- 7 yr, were studied, 8 with
"whiplash"-type injuries (average duration 22.5 wk) and 16 with
nontraumatic chronic neck pain (average duration 110 wk). INTERVENTION: No therapeutic intervention
is reported. MAIN OUTCOME MEASURE: Pressure
levels generated by subjects against a modified sphygmomanometer-type
dynamometer as measured in kilopascals. RESULTS:
Study 1. Repeated paired trials of a standardized weight column (20 lbs)
produced a coefficient of variation of 0.84% and virtually no difference
between the means of the first vs. second trials. Study 2. High test-retest
correlation coefficients were found for all ranges of motion (.79-.97).
Right-to-left asymmetry in rotation and lateral flexion was within 6-8%. The
flexion/extension ratio was .57:1, indicating that in normal subjects,
flexion was approximately 40% lower than extension. Lower cutoffs were
established as the mean--1 SD as follows (in kPa): flexion--3300,
extension--5800, rotation--5200 and lateral flexion--6200. Coefficients of
variation ranged from 25 to 29%. Study 3. Differences between paired trials
were analyzed by intraclass coefficients, which were very high (.95-.99), and
by percentages, which ranged from 4 to 10.4%, with an average of 7%,
indicating a high degree of test-retest consistency. The mean values for all
symptomatic subjects for flexion, extension, right rotation and right lateral
bending were all well below the normal cutoff values as found in study 2. The
flexion/extension ratio for whiplash subjects was 0.25:1.00, which is half of
that of normal subjects. CONCLUSIONS:
The MSD has been found to be a reliable instrument for the evaluation of
isometric muscle strength in the neck in normal and symptomatic subjects.
Normative values for absolute test levels, bilateral symmetry and
flexion/extension ratios have been determined. A symptomatic group demonstrated significant deviations from these
norms in the form of reduced strength levels and reduced flexion/extension
ratios, while still maintaining very high levels of test-retest consistency
and bilateral symmetry. The MSD appears very promising in the
evaluation of neck-injured patients.
|
|
Effect of osteopathic medical management on neurologic development in
children,
Frymann VM, Carney RE, Springall P.
|
J Am Osteopath Assoc.
1992 Jun;92(6):729-44.
Abstract: For 3 years,
children between 18 months and 12 years of age with and without recognized
neurologic deficits were studied at the Osteopathic Center for Children.
Their response to 6 to 12 osteopathic manipulative treatments directed to all
areas of impaired inherent physiologic motion was estimated from changes in
three sensory and three motor areas of performance. Houle's Profile of
Development was used to compare neurologic with chronologic age and rate of
development, and scores were age-adjusted. Results in children after
treatment were compared with those following a waiting period without
treatment. Neurologic performance significantly improved after treatment in
children with diagnosed neurologic problems and to a lesser degree in
children with medical or structural diagnoses. The advances in neurologic
development continued over a several months' interval. The results support
the use of osteopathic manipulative treatment as part of pediatric healthcare
based on osteopathic medical philosophy and principles.
|
|
Postural
control in young and elderly adults when stance is perturbed: kinematics,
Alexander, N. B, Shepard, N, Gu, MJ, Schultz, A.
|
Journal of Gerontology, 1992; 47:M79-M87.
Abstract: Increased
postural sway and falling are associated with aging and are likely related to
problems with postural control in the elderly. We investigated the motions of
individual body segments in 24 healthy young adults and 15 healthy elderly
adults (mean ages 26 and 72) in response to four tasks: (a) standing with
feet flat on an anteriorly accelerating platform (Flat Translation); standing
on a narrow beam support that was (b) stationary (Beam Standing) and (c)
accelerating anteriorly (Beam Translation); and (d) standing on a rotatable
but otherwise stationary springboard (Springboard Standing). An
optoelectronic camera system was used to measure rotations of body segments,
particularly regarding their maximum excursions, time to first rotation
response, direction of initial rotation, and time to first rotation reversal.
In general, larger rotation excursions were noted in the elderly compared to
the young group, particularly in the Beam Standing and Beam Translation
tasks, but the magnitude of rotation difference was small. All rotation
magnitudes were well within the available ranges of motion of the body
joints. In both excursion magnitudes and directions of initial rotation, the
elderly showed greater variability than the young. In the Beam Translation
task, the elderly group, compared to the young, tended to rotate their upper
body segments more than in the Flat Translation task. These data suggest that
healthy elderly adults with no apparent musculoskeletal or neurological
impairments have small but consistent differences in postural control
kinematics, particularly when more challenging conditions are presented.
Moreover, these data provide the basis for biomechanical analyses of joint
torques and other dynamic requirements of these responses.
Comment: Manual muscle
testing is the method of testing functional neurology and postural mechanisms
in applied kinesiology. Normally there is predictable facilitation and
inhibition of muscle function. When there is not, applied kinesiology testing
methods are employed to discover and correct the factors responsible for the
disturbance in predictable muscle function. The importance of restoring
normal function in elderly patients is demonstrated by the postural kinematic
disturbances of the patients in this study.
|
|
The stabilizing system of the spine. Part I. Function, dysfunction,
adaptation, and enhancement, Panjabi MM.
|
J Spinal Disord, 1992
Dec;5(4):383-9; discussion 397.
Abstract: Presented here
is the conceptual basis for the assertion that the spinal stabilizing system
consists of three subsystems. The vertebrae, discs, and ligaments constitute
the passive subsystem. All muscles and
tendons surrounding the spinal column that can apply forces to the spinal
column constitute the active subsystem. The nerves and central
nervous system comprise the neural subsystem, which determines the
requirements for spinal stability by monitoring the various transducer
signals, and directs the active subsystem to provide the needed stability. A
dysfunction of a component of any one of the subsystems may lead to one or
more of the following three possibilities: (a) an immediate response from other subsystems to successfully
compensate, (b) a long-term adaptation response of one or more
subsystems, and (c) an injury to one or more components of any subsystem. It
is conceptualized that the first response results in normal function, the
second results in normal function but with an altered spinal stabilizing
system, and the third leads to overall system dysfunction, producing, for
example, low back pain. In situations where additional loads or complex
postures are anticipated, the neural
control unit may alter the muscle recruitment strategy, with the
temporary goal of enhancing the spine stability beyond the normal
requirements.
Comment: This paper
elegantly describes a number of the fundamental tenets of AK. Under normal
conditions, structural balance is maintained by the muscles of the body (“the
active subsystem”), that is controlled by the nervous system. With MMT, when
a muscle tests as inhibited, treatment to the portion of the nervous system
causing the inhibition restores the muscle to normal facilitation.
Importantly, Dr. Panjabi suggests that changes in neural function produces
immediate changes in muscle function. This correlation is at the center of
the successes achieved using AK therapeutics.
|
|
The stabilizing system of the spine. Part II. Neutral zone and
instability hypothesis, Panjabi MM
|
J Spinal Disord, 1992
Dec;5(4):390-6; discussion 397.
Abstract: The neutral
zone is a region of intervertebral motion around the neutral posture where
little resistance is offered by the passive spinal column. Several
studies--in vitro cadaveric, in vivo animal, and mathematical
simulations--have shown that the neutral zone is a parameter that correlates
well with other parameters indicative of instability of the spinal system. It
has been found to increase with injury, and possibly with degeneration, to decrease
with muscle force increase across the spanned level, and also to
decrease with instrumented spinal fixation. In most of these studies, the
change in the neutral zone was found to be more sensitive than the change in
the corresponding range of motion. The neutral zone appears to be a
clinically important measure of spinal stability function. It may increase
with injury to the spinal column or with
weakness of the muscles, which in turn may result in spinal instability or a
low-back problem. It may decrease, and may be brought within the
physiological limits, by osteophyte formation, surgical fixation/fusion, and muscle strengthening. The spinal
stabilizing system adjusts so that the neutral zone remains within certain
physiological thresholds to avoid clinical instability.
Comment: Unless there is
a bony deformity, muscle imbalance is basic to structural distortion and
changes in the motion and positioning of the spinal joints. For distortions
in the kinematics of the neutral zone or for spinal subluxations to be
maintained, muscle imbalance must be present. Dr. Panjabi’s paper once again
elucidates several fundamental tenets of AK.
|
|
Intrarater reliability of manual muscle test
(Medical Research Council scale) grades in Duchenne's muscular dystrophy, Florence JM, Pandya S, King WM, Robison JD,
Baty J, Miller JP, Schierbecker J,
Signore LC.
|
Phys
Ther. 1992 Feb;72(2):115-22; discussion 122-6
Abstract: The purpose of this study was to document the
intrarater reliability of manual muscle test (MMT) grades in assessing muscle
strength in patients with Duchenne's muscular dystrophy (DMD).
Subjects were 102 boys, aged 5 to 15 years, who were participating in a
double-blind, multicenter trial to document the effects of prednisone on
muscle strength in patients with DMD. Four physical therapists participated
in the study. Two identical (duplicate) evaluations were performed within 5
days of each other by the same examiner initially and after 6 and 12 months
of treatment. A total of 18 muscle groups were tested on each patient, 16 of
them bilaterally, using a modification of the Medical Research Council scale.
Reliability of muscle strength grades obtained for individual muscle groups
and of individual muscle strength grades was analyzed using Cohen's weighted
Kappa. The reliability of grades for
individual muscle groups ranged from .65 to .93, with the proximal muscles
having the higher reliability values. The reliability of individual muscle
strength grades ranged from .80 to .99, with those in the gravity-eliminated
range scoring the highest. We conclude the MMT grades are reliable for
assessing muscle strength in boys with DMD when consecutive evaluations are
performed by the same physical therapist.
|
|
Cervicogenic dysfunction in muscle contraction headache and migraine:
a descriptive study, Vernon H, Steiman I, Hagino C.
|
J Manipulative Physiol Ther. 1992
Sep;15(7):418-29.
OBJECTIVE: The prevalence
and nature of findings of cervicogenic dysfunction is explored in subjects
with muscle contraction/tension-type (MCH) headache and common migraine
without aura (CM). DESIGN:
Descriptive survey. SETTING: Chiropractic
outpatient research clinic. PATIENTS:
Forty-seven (47) subjects, aged 18-55 with two categories of benign headache,
were studied: MCH (tension-type) n = 19 (6 males, 13 females) and CM (without
aura), n = 28 (3 males, 25 females). Subjects were recruited as part of an
intervention trial and, thus, form a consecutive sample of patients. The
present findings were elicited as part of the initial assessment. INTERVENTION: No therapeutic intervention
is reported. MAIN OUTCOME MEASURES: Standardized
headache history; plain film and dynamic spinal X rays; motion palpation; and
pressure algometry. RESULTS: For
CM, the most prevalent headache locations were frontal (81%) and occipital
(78%). Neck pain and upper back pain accompanied headache in 90% and 41% of
subjects, respectively. For MCH, the most prevalent headache locations were
occipital (87%) and frontal (81%). Neck and upper back pain accompanied
headache in 100% and 27%, respectively, of all subjects. For the total group,
77% of all subjects and 89% of females exhibited a marked reduction, absence
or reversal of the normal cervical lordosis. Ninety-seven percent of all
subjects exhibited, on dynamic X-ray studies, at least one significant
abnormality of segmental mobility from C1 to C7, while 43% exhibited
abnormalities at four or more segments. Segmental motion at C0-C1 was reduced
in 90% of subjects in flexion and 70% of subjects in extension. On motion
palpation, 84% of CM and MCH subjects were found to have at least two major
fixations from C0 to C2. On pressure algometry, 92% of CM and 85% of MCH had
at least one verifiable tender point (TP) in the upper cervical region. The
most common locations for TPs were mid-cervical (C2-C3), lateral occipital
and suboccipital. CONCLUSIONS:
Both MCH and CM subjects demonstrate high occurrences of: a) occipital and
neck pain during headaches; b) tender points in the upper cervical region; c)
greatly reduced or absent cervical curve; and d) X-ray evidence of joint
dysfunction in the upper and lower cervical spine. These findings support the
premise that the neck plays an important, but largely ignored role in the
manifestation of adult benign headaches. A case-control study should be
conducted to confirm the greater prevalence of cervicogenic dysfunction in
headache as compared to nonheadache subjects.
|
|
Quantitative cervical flexor strength in healthy subjects and in
subjects with mechanical neck pain, Silverman JL,
Rodriquez AA, Agre JC.
|
Arch Phys Med Rehabil. 1991
Aug;72(9):679-81.
Abstract: Although weakness of anterior cervical muscles is
postulated to contribute to persistent neck pain in patients with mechanical
neck pain, quantitation of weakness has never been reported. We
compared anterior cervical muscle strength in 30 subjects with mechanical
neck pain and in 30 asymptomatic control subjects. Testing was performed with
the subject supine, chin retracted, and neck flexed. Assessment was made
using a hand-held dynamometer with head held at the midline and with rotation
left and right within a pain-free range. Analysis with Wilcoxon scores showed
that patients with neck pain had significantly less (p less than .05)
strength (N.Kg-1) in all three positions than controls (1.16 +/- 0.49 vs.
1.71 +/- 0.42, sagittally; 1.01 +/- 0.52 vs. 1.47 +/- 0.41, rotation left;
.99 +/- 0.46 vs. 1.43 +/- 0.43 rotation right; neck pain vs. control,
respectively.) This weakness and its role
in persistent neck pain should be recognized. The efficiency and
effect of cervical muscle strengthening in treatment of chronic neck pain
should be further defined.
Comment: This paper
gives evidence for one of the fundamental tenets of AK and is very important.
AK theorizes that physical imbalances are
associated with secondary muscle dysfunction – specifically a muscle
inhibition -- usually preceding an overfacilitation of an opposing muscle.
Applying the proper therapy results in improvement in the inhibited muscle.
|
|
Reliability of testing measures in Duchenne or
Becker muscular dystrophy, Barr AE, Diamond BE,
Wade CK, Harashima T,
Pecorella WA, Potts CC, Rosenthal H, Fleiss JL, McMahon DJ.
|
Arch
Phys Med Rehabil. 1991 Apr;72(5):315-9.
Abstract: In a
multiinstitutional collaborative study, we ascertained the interevaluator and
intraevaluator reliability of six physical therapists who performed
assessment measures on 36 boys (11.7 +/- 3.9 years) with Duchenne or Becker
muscular dystrophy. Upper and lower extremities were evaluated by manual
muscle testing for function, range of motion, and strength. The data were
analyzed using intraclass correlation coefficients (ICCs). For the
interevaluator phase, ICCs were as follows: average
muscle strength, .90; range of motion, .76; and upper extremity functional
performance, .58. For the intraevaluator phase, corresponding ICCs were .80
to .96; .33 to .97; .34 to 1.00. Our results confirm and extend observations
by others that these assessment measures are sufficiently reliable for use in
a multiinstitutional collaborative effort. Such results can be used to design
clinical trials that have sufficient statistical power to detect changes in
the rate of disease progression. Investigators planning clinical
trials in a multiinstitutional collaborative setting should first standardize
the assessment methods, provide evaluator training, and document reliability.
|
|
Effects of restrained cervical mobility on voluntary eye movements
and postural control, Karlberg M, Magnusson M,
Johansson R.
|
Acta Otolaryngol, 1991;111(4):664-70.
Abstract: The effects
of restrained cervical mobility on pursuit eye movements (PEMS), voluntary
saccades and postural control, as measured by posturography, were studied in
11 healthy subjects whose cervical spine movement had been restrained for 5
days by means of a rigid neck-collar. At day 5 mean peak velocity of voluntary
saccades at amplitudes of 40 degrees and 60 degrees was significantly
reduced, as was mean peak gain of PEMs at a stimulus velocity of 50
degrees/s; the variance of body position in vibration-induced body sway was
significantly increased, but there was no difference in variance of
galvanically-induced body sway or in velocity of vibration-induced body sway.
The results suggest that restriction of cervical movements per se affects
voluntary eye movements, a conclusion also consistent with findings in
patients with tension headache. Restriction of cervical movement only
marginally affects postural control.
Comment: In applied
kinesiology chiropractic methodology, a means for testing the integration of
the muscles in the body with the visual reflexes has been termed ocular lock.It demonstrates the failure of the
eyes to work together on a binocular basis through the cardinal fields of
gaze. When the eyes are turned in a
specific direction, a previously strong indicator muscle will weaken when the
ocular lock test is positive, and there is probably disturbance in the visual
righting, vestibulo-ocular, or opto-kinetic reflexes. The eyes must work together as a team so that each
eye is directed to the same fixation point on a page, somewhat like two spotlights
highlighting a dancer at the center of the stage. This is called convergence. The focus of the eyes must also be
quickly adjusted from one distance or angle to another, called accommodation. The eyes must be able to track or scan
along the horizon or a line of print smoothly and evenly so that the brain
can receive a flow of sequentially correct visual information. This is called tracking. Eye motion and position are integrated
with proprioceptors throughout the body, as well as those of the vestibular
apparatus and head-on-neck reflexes. This is usually not gross
pathology of cranial nerves III, IV, and VI; rather it is poor functional
organization. Mechanical irritation of cranial nerves III, IV, or VI (usually
VI) may be responsible for disturbed binocular function leading to discordant
sensory inputs from the visual righting reflex. This paper shows that
erroneous cervical spine sensory information converges in the central nervous
system with the visual system, and this could affect the perception of body
orientation and lead to a misinterpretation of relation to the surrounding.
|
|
Forefoot pain associated with muscle strain in the
lower extremity, Hsieh
CY.
|
J
Manipulative Physiol Ther. 1991 Nov-Dec;14(9):527-9.
Abstract: A case of
forefoot pain at the first metatarsophalangeal joint is discussed. Local treatment with ultrasound failed to bring
significant relief. However, dramatic and lasting relief occurred when
treatment was applied to the muscle belly of the extensor hallucis longus.
The patient also suffered from hallux valgus with mild foot pronation. Two
years after therapy, the patient stated she had not experienced any foot pain
since the last treatment, and she continued to wear the prescribed flexible
foot orthotics on a daily basis.
|
|
The pain-adaptation model: a discussion of the
relationship between chronic musculoskeletal pain and motor activity, Lund,
J.P., et al.
|
Canadian Journal of Physiology and
Pharmacology, 1991;69:683-694.
Abstract: Articles
describing motor function in five chronic musculoskeletal pain conditions
(temporomandibular disorders, muscle tension headache, fibromyalgia, chronic
lower back pain, and postexercise muscle soreness) were reviewed. It was
concluded that the data do not support the commonly held view that the pain
of these conditions is maintained by some form of tonic muscular
hyperactivity. Instead, it seems clear that in these conditions the activity
of agonist muscles is often reduced by pain, even when this does not arise
from the muscle itself. On the other hand, pain causes small increases in the
level of activity of the antagonist. As a consequence of these changes, force
production and the range and velocity of movement of the affected body part
are often reduced. To explain how such changes in the behavior come about, we
propose a neurophysiological model based on the phasic modulation of
excitatory and inhibitory interneurons supplied by high-threshold sensory
afferents. We suggest that the "dysfunction" that is characteristic
of several types of chronic musculoskeletal pain is a normal protective
adaptation and is not a cause of pain.
Comment: This paper
articulates with fascinating similarity one of the major hypotheses in AK,
namely that physical, chemical, or emotional imbalances produce secondary
muscle dysfunction, specifically a muscle inhibition (usually followed by
overfacilitation of an opposing muscle). Muscles lose function and become
inhibited because of structural problems like trauma or chemical imbalance
due to a hormonal influence or mental/emotional stress.
|
|
Musculoskeletal ontogeny,
phylogeny, and functional adaptation, Carter DR, Wong M, Orr TE.
|
J Biomech.
1991;24 Suppl 1:3-16.
Abstract:
Physical forces applied to connective tissues may cause significant
changes in cell metabolism and gene expression. Theoretical investigations
indicate that mechanical loading histories beginning very early in skeletal
development may guide endochondral ossification patterns and the initial
architectural construction of bones. Developmental patterns and structures of
bones can be emulated using mathematical algorithms or "rules of
construction" which relate developmental processes to tissue stress (or
strain) histories. Skeletal forms and tissues are well-designed for their
mechanical function primarily because their histomorphological construction
has been guided by mechanical loading during growth and development.
Construction rules of developmental mechanics can also be used to describe
many of the histological and morphological adaptations of mature skeletal
tissues to changes in customary physical activity. Over many generations,
changes in the heritable genetic information occurs by mutation and genetic
variability. The range of skeletal forms that are possible in evolution due
to such variations, however, is constrained by the developmental rules of
construction that reflect biophysical processes associated with the tissue
mechanical loading.
Comment: This study
shows how the intraosseous distortions of skeletal bones occur. These are
found in AK to affect the spine, the cranium, and the extremities. Specific
means of testing for abnormal intraosseous distortions have been developed in
AK for treatment.
|
|
Effects of Soft Tissue Technique and Chapman's
Neurolymphatic Reflex Stimulation on Respiratory Function, Lines, D., McMillan, A., Spehr, G.
|
J Aust Chiro Assoc 1990 Mar;20(1):17-22.
Thirty asymptomatic subjects were treated on four separate occasions using soft tissue technique and Chapman's neurolymphatic reflex stimulation for the diaphragm. Spirometric assessment of respiratory function before and after each treatment was performed. Measurements of forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC% over the whole sample showed no significant improvement following the treatment regime. Eight of the thirty subjects had lower than predicted initial FVC and FEV1 values. Five of these subjects reported a past history of asthma or bronchitis. When the results for this group of eight subjects were analyzed separately, it was found that a significant improvement was attained from the first pre-treatment FVC to the last post-treatment FVC (paired t-test significant at alpha = 0.02). These results suggest that traditional chiropractic soft tissue and reflex techniques may have therapeutic value in the treatment of patients who exhibit below average respiratory function. |
|
Limb Segment
Information Transmission Capacity Infers Integrity of Spinothalamic Tracts
and Cortical Visual-Motor Control, Leisman, G., Vitori, R.
|
International Journal of Neuroscience. 1990;
50:175-183.
Abstract: Limb segment
movement times have been investigated previously in relation to Fitts’ Index
of Difficulty (ID = log22A/W) over various movement distances.
Results supported Fitts’ theory that different limb segments show different
maximum information processing rates. The results indicated that
visually-mediated discrete correction control processes are used. In the
presently reported experiments, normal human subjects performed movements with
left or right arms. Visual-motor control was inter- or intrahemispheric.
Direction of movement was adductive or abductive. It was hypothesized that
abductive movements are controlled by the contralateral hemisphere while
adductive movements are controlled by either hemisphere. It was also
hypothesized that abductive movements are related to the lateral system which
projects to the contralateral side of the spinal cord. The control of
adductive movements is related to the medial system which projects bilaterally
to the spinal cord.
|
|
Spinal learning: central modulation of pain
processing and long-term alteration of interneuronal excitability as a result
of nociceptive peripheral input, Slosberg M.
|
J
Manipulative Physiol Ther. 1990 Jul-Aug;13(6):326-36
Abstract: The
influence of nociceptive peripheral input on the response characteristics of
spinal interneurons may result in long-term alterations of interneuronal
excitability and modify their responses to subsequent stimuli. Such
neuromodulation has been found to result in physiological changes including
hyperalgesia, lowering of pain thresholds, expansion of receptive fields and changes in response behaviors of muscles.
These types of alterations may contribute to clinically significant findings
including muscle spasm, hypomobility, edema, chronic pain, recurrences in
areas of previous injury and resistance to treatment. This article reviews
studies concerning plasticity of response behaviors of interneurons including
habituation, spinal learning, spinal fixation, neuromodulation and the
effects of substance P. Potential clinical and chiropractic application are
discussed and a brief review of clinically relevant studies of chiropractic
adjustments are cited.
Comment: This paper
provides biological plausibility to the hypothesis of the AK “challenge method.” Challenge tests
are maneuvers performed by the examiner for stimulating subtle muscular
changes in the body via mechanoreceptors in muscles, meninges, diarthrodial joints,
ligaments or tendons, associated with the spine, cranial sacral mechanism, or
extraspinal articulations.
|
|
Interactions between non-symmetric mechanical vector
forces in the body and the autonomic nervous system: basic requirements for
any mechanical technique to engender long-term improvements in autonomic
function as well as in the functional efficiency of the respiratory,
cardiovascular, and brain systems, Kullok S, Mayer C, Backon J, Kullok J.
|
Med
Hypotheses. 1990 Jul;32(3):173-80.
Abstract: There are
known anatomical asymmetries in the respiratory, cardiovascular, and nervous
system. The coupling mechanisms between each of these systems--lungs-heart,
heart-brain, and lungs-brain--are also asymmetrical. There is a growing body
of literature indicating that mechanical pressure asymmetrically applied to
certain areas of the human body produces changes in the balance of autonomic
parameters. These findings implicitly indicate that not only magnitude but
also the direction and point of application of the force play a role in its
influence upon the autonomic nervous system. Therefore, we suggest that
asymmetrical vector forces resulting from the mechanical activity of the
lungs, heart and blood moving throughout the circulatory system, will also
produce a lateralization effect in autonomic balance. We postulate the
existence of negative feedback loops between brain autonomic control and
mechanical functions in the body as a fundamental part of the body's
homeostatic mechanisms. It follows that any
mechanical assist to the respiratory or cardiovascular system will be
significantly reduced or even eliminated if these homeostatic mechanisms are
not taken into account. Our
hypothesis predicts that a long-term improvement in autonomic balance as well
as in respiratory, cardiovascular, and brain function can be achieved if
mechanical forces are applied to the body with the aim of reducing existing
imbalances of mechanical force vectors. This technique implies
continually controlling for precise timings resulting from physiological
periodical forces as well as factors derived from anatomical and coupling
asymmetries in the respiratory, cardiovascular, and nervous systems.
|
|
Shoulder pain and
repetition strain injury to the supraspinatus muscle: etiology and
manipulative treatment, Jacobson EC, Lockwood MD, Hoefner VC Jr,
Dickey JL, Kuchera WL.
|
J Am Osteopath Assoc.
1989 Aug;89(8):1037-40, 1043-5.
Abstract: Chronic
inflammation and degenerative tendonitis of the supraspinatus muscle is an
important cause of intrinsic shoulder pain. Injury to this muscle is usually
caused, not by a single event, but by slight to moderate trauma repeatedly to
the same anatomic area. The term repetition strain injury is used to describe
this form of microtrauma. Repetition strain injury of the supraspinatus
muscle is not an isolated event, but rather a form of microtrauma that
affects the entire shoulder girdle. This functional unit must be evaluated
and considered in the treatment plan. The authors discuss the diagnosis of
this pain syndrome, which is based on the patient's work history, motion and
strength testing, and palpation for trigger points. They also provide
instruction in treatment involving manipulation with functional and
counterstrain techniques combined with home exercise and modification of work
posture.
|
|
Stability of the lumbar
spine. A study in mechanical engineering, Bergmark A.
|
Acta Orthop Scand Suppl. 1989;230:1-54.
Abstract: From the
mechanical point of view the spinal system is highly complex, containing a
multitude of components, passive and active. In fact, even if the active
components (the muscles) were exchanged by passive springs, the total number
of elements considerably exceeds the minimum needed to maintain static
equilibrium. In other words, the system is statically highly indeterminate.
The particular role of the active components at static equilibrium is to
enable a virtually arbitrary choice of posture, independent of the
distribution and magnitude of the outer load albeit within physiological
limits. Simultaneously this implies that ordinary procedures known from the
analysis of mechanical systems with passive components cannot be applied.
Hence the distribution of the forces over the different elements is not
uniquely determined. Consequently nervous control of the force distribution
over the muscles is needed, but little is known about how this achieved. This
lack of knowledge implies great difficulties at numerical simulation of
equilibrium states of the spinal system. These difficulties remain even if
considerable reductions are made, such as the assumption that the thoracic
cage behaves like a rigid body. A
particularly useful point of view about the main principles of the force
distributions appears to be the distinction between a local and a global
system of muscles engaged in the equilibrium of the lumbar spine. The local system consists of muscles with
insertion or origin (or both) at lumbar vertebrae, whereas the global system consists of muscles
with origin on the pelvis and insertions on the thoracic cage. Given the
posture of the lumbar spine, the force distribution over the local system
appears to be essentially independent of the outer load of the body (though
the force magnitudes are, of course, dependent on the magnitude of this
load). Instead different distributions of the outer load on the body are met
by different distributions of the forces in the global system. Thus, roughly
speaking, the global system appears to take care of different distributions
of outer forces on the body, whereas the local system performs an action,
which is essentially locally determined (i.e. by the posture of the lumbar
spine). The present work focuses on the upright standing posture with
different degree of lumbar lordosis. The outer load is assumed to consist of
weights carried on the shoulders. By reduction of the number of unknown
forces, which is done by using a few different principles, a unique
determination of the total force distributions at static equilibrium is
obtained.
|
|
Reliability of
quantitative muscle testing in healthy children and in children with Duchenne
muscular dystrophy using a hand-held dynamometer, Stuberg WA, Metcalf WK.
|
Phys
Ther. 1988 Jun;68(6):977-82.
Abstract:
The purpose of this study was to examine intratester and test-retest
reliability using a hand-held dynamometer for the measurement of isometric
muscle strength in 28 healthy children and children with Duchenne muscular
dystrophy. The Dystrophic Group consisted of 14 children diagnosed with
Duchenne muscular dystrophy, and the Healthy Group consisted of 14
age-matched children with no history of orthopedic or neuromuscular
disorders. One physical therapist tested hip and knee extension, elbow
flexion, and shoulder abduction in each child bilaterally. A two-way analysis
of variance for repeated measures was used to analyze differences between
measurements taken within and across the testing sessions. Pearson
product-moment correlation coefficients were determined on mean values across
the testing sessions for each variable. No significant differences (p greater
than .05) between measurements taken within or across testing sessions were
found in either the Dystrophic Group or the Healthy Group. Correlation
coefficients for the Dystrophic Group ranged from .83 to .99 for the
variables tested. Correlation coefficients for the Healthy Group ranged from
.74 to .99. The results suggest that the hand-held dynamometer can be used as
a reliable instrument in measuring the isometric strength of selected muscles
in children.
|
|
Influence of different
static head-body positions on spinal lumbar interneurons in man: the role of
the vestibular system, Rossi A, Mazzocchio R.
|
ORL J Otorhinolaryngol Relat Spec,
1988;50(2):119-26.
Abstract: The present
experiments were made in man with the aim of studying the possible influences
of different head-body tilts on the activity of the interneurons Ia, Ib and
the Renshaw cells functionally coupled to the soleus alpha-motoneurons.
Subjects were seated on a chair, rotable with respect to the vertical axis,
and were studied at 80 degrees and 40 degrees to the horizontal. The
excitability of the soleus alpha-motoneurons slightly decreased when the body
was placed at 40 degrees of backward inclination whereas the Renshaw cell
activity showed a reinforcement of inhibition on the same motoneurons. The
reciprocal inhibition from the anterior tibial to the soleus muscle increased
at 40 degrees of backward inclination with respect to the control values at
80 degrees. Finally, short-latency homonymous facilitation and inhibition
showed no significant change in relation to body position. The results
indicate that different head-body positions are able to modify the bias of
spinal interneurons in man. We discuss the hypothetical role of the
vestibular system in producing the effects seen.
Comment: The
labyrinthine and visual righting reflexes may be disturbed by joint or muscle
problems in the neck, as well as by cranial faults that may result from
either whiplash dynamics or a blow to the head during an automobile accident
or other head and neck trauma. It is hypothesized in AK that temporal bone
cranial faults can result in imbalance in one or both sternocleidomastoid and
upper trapezius muscles due to mechanical irritation of cranial nerve XI as
it exits the skull through the jugular foramina, and could thereby disturb
the biomechanics of the joints in the neck. This phenomenon is found on a
daily basis in the clinical setting, and muscles anywhere in the body may be
facilitated by proper cranial therapy. Anatomical distortions of the geometry
of the vestibular mechanism within the temporal bones (producing a tilt in
the angular geometry of the semicircular canals) may create discordant
sensory input into the CNS compared to that coming into it from the spinal
joints and muscles, thereby producing poor stability and deficient motor
activity.
|
|
Effects of altered
afferent articular input on sensation, proprioception, muscle tone and
sympathetic reflex responses, Slosberg M.
|
J Manipulative Physiol Ther. 1988
Oct;11(5):400-8.
Abstract:
The influence of afferent articular and periarticular input on muscle tone,
joint mobility, proprioception and pain is of considerable interest to
practitioners using manipulation. It has long been
hypothesized that dysfunctional articulations may generate altered patterns
of afferent input. This article reviews the relevant studies that have
investigated the impact of articular input on efferent activity under normal
conditions and under conditions of altered joint function. The findings suggest that sensory input does have a
substantial effect on efferent function and sensation.
Furthermore, the studies indicate that the pattern of articular input may be
significantly modified by joint inflammation, trauma and effusion and result
in changes of muscle tone, joint mobility, proprioception and pain.
Comment: This paper
provides biological plausibility to the hypothesis of the AK “challenge method.” Challenge tests
are maneuvers performed by the examiner for stimulating subtle muscular
changes in the body via mechanoreceptors in muscles, meninges, diarthrodial
joints, ligaments or tendons, associated with the spine, cranial sacral
mechanism, or extraspinal articulations.
|
|
Comparison of lumbar
paravertebral EMG patterns in chronic low back pain patients and non-patient
controls,
Ahern DK, Follick MJ, Council JR, Laser-Wolston N, Litchman H.
|
Pain. 1988
Aug;34(2):153-60.
Abstract:
According to myogenic models that relate abnormal EMG patterns to the
experience of pain, lumbar paravertebral muscle activity has been considered
to play an important role in chronic low back pain. In the present study, 40
chronic low back pain patients and 40 matched non-patient controls were
compared on lumbar paravertebral EMG during mechanically stabilized static
and dynamic postures. Differences between groups in lumbar curvature and
spinal range of motion were determined using a dual goniometer technique.
Although the two groups did not differ on absolute levels of EMG during quiet
standing, significant differences were
found for EMG patterns during dynamic postures. In addition, most
patients did not show the flexion-relaxation response or the expected pattern
of EMG responses during trunk rotation, most likely because of restricted
range of motion and/or compensatory posturing. These findings provide support
for the biomechanical model of chronic pain and indicate the need for further
research pertaining to pain behavior and movement-related lumbar muscle
activity.
|
|
Intrarater
reliability of manual muscle testing and hand-held dynametric muscle testing,
Wadsworth CT, Krishnan R, Sear M, Harrold J, Nielsen DH.
|
Phys Ther. 1987 Sep;67(9):1342-7.
Physical therapists require an accurate, reliable method for
measuring muscle strength. They often use manual muscle testing or hand-held
dynametric muscle testing (DMT), but few studies document the reliability of
MMT or compare the reliability of the two types of testing. We designed this
study to determine the intrarater reliability of MMT and DMT. A physical
therapist performed manual and dynametric strength tests of the same five
muscle groups on 11 patients and then repeated the tests two days later. The
correlation coefficients were high and significantly different from zero for
four muscle groups tested dynametrically and for two muscle groups tested
manually. The test-retest reliability coefficients for two muscle groups
tested manually could not be calculated because the values between subjects
were identical. We concluded that both MMT and DMT are reliable testing
methods, given the conditions described in this study. Both testing methods
have specific applications and limitations, which we discuss.
|
|
Changes in
Electrical Activity in Muscles Resulting from Chiropractic Adjustment: A
Pilot Study, Shambaugh P.
|
J Manipulative Physiol Ther 1987;10(6):300-304.
This study examines the effects of chiropractic adjustment on
the muscles of the back. Vertebrae that are hypomobile may be held in that
state by the erector spinae muscle group; adjusting such vertebrae should
result in less muscle tension. By measuring the change in electrical
activity, such relaxation can be observed. Hypomobile vertebrae were found by
motion palpation. The patient was then placed prone and surface electrodes
were placed over the upper trapezius, upper erector spinae (T3-T5), and
lumbar erector spinae (L1-L3) muscle groups on both sides of the body. The
patient was adjusted using full spine toggle recoil thrusts, and
postadjustment readings were taken. Results from this study show that
significant changes in muscle electrical activity occur as a consequence of
adjusting. On average, a 25% reduction in muscle activity was observed across
the 20 subjects tested, while no significant reductions were observed with
the control group of 14 subjects. Significant reductions in side-to-side
imbalances were also observed.
|
|
Effects of
joint pathology on muscle, Young A, Stokes M, Iles JF.
|
Clin Orthop Relat Res, 1987
Jun;(219):21-7.
Abstract:
The muscle wasting associated with joint damage may be highly
selective; knee disorders produce quadriceps wasting but little change in the
size of the hamstrings. This causes isolated quadriceps weakness, so
predisposing to a position of knee flexion. Nociceptors and other receptors
in and around the joint can have flexor excitatory and extensor inhibitory
actions. At the knee, these receptors are likely to excite hamstrings and
inhibit quadriceps. Although other actions could occur, quadriceps inhibition
may be favored by a position of knee extension. Quadriceps inhibition will
weaken voluntary contraction, reduce tone, and contribute to wasting of the
muscle, further predisposing to a position of knee flexion. The potency of
quadriceps inhibition may be considerable, even in the absence of perceived
pain. A small, apparently trivial effusion (or even a clinically undetectable
effusion) may cause important inhibition. In order to improve the
orthopedist's ability to prevent flexion contracture of the injured or
operated joint, he must look not only for ways of reducing joint pain, but
also for ways of preventing activity in other joint afferents. For example,
he must consider the possible effects of joint position, intraarticular
pressure, suture-line tension, and afferent blockade.
Comment: This study
demonstrates that structural alterations in the knee joints produce immediate
and measurable weaknesses in the muscles that support and stabilize the knee.
If the muscles at the front of the knee (quadriceps) are weak, this may
produce joint instability and perpetuate the knee joint dysfunction until
corrected.
|
|
Quantifying
the Effects of Spinal Manipulations on Gait, Using Patients with Low Back
Pain: A Pilot Study, Herzog W, Nigg B, Robinson R, Read L.
|
J Manipulative Physiol Ther 1987;10(6):295-299
A pilot study was performed to investigate the effects of
chiropractic treatment on the gait of one patient with a chronic sacroiliac
joint syndrome. Qualitative and quantitative measures were used to describe
pain, sacroiliac joint mobility, functional ability and gait patterns of this
patient before and after receiving chiropractic treatment, and throughout the
rehabilitation period. For this patient, chiropractic treatment reduced the
low back pain and was associated with significant changes in selected gait
parameters. A study involving 10-20 subjects is under way to possibly
generalize the findings of this investigation.
|
|
Finger
flexion function in rheumatoid arthritis: the reliability of eight simple
tests, Armstrong R, Horrocks A, Rickman S, Heinrich I, Kay A, Gibson T.
|
Br J Rheumatol 1987;26:118-122.
The inter- and intra-observer errors of eight tests of finger
flexion function were estimated from the results obtained by three observers
assessing 10 patients with rheumatoid hand involvement. Measurements of
finger flexion and muscle power involved both conventional and novel techniques
using simple and easily constructed apparatus. For each test, measurements
were in agreement between observers and were reproducible on three occasions.
These tests may now be used with confidence by other investigators.
|
|
Functional
assessment of the hand: reproducibility, acceptability, and utility of a new
system for measuring strength, Helliwell P, Howe A, Wright V.
|
Ann Rheum Dis 1987;46:203-208
A new system for measuring strength of the hand using a torsion
dynamometer linked to a microprocessor is described. The system permits
analysis of timed squeezes of both grip and pinch and is adjustable to all
sizes of hand and degrees of hand deformity. Results obtained with the system
were found to be reproducible, and the rigid device was acceptable to a group
of patients with arthritic hands. In rheumatoid arthritis, there is a marked
reduction in maximum grip and pinch strength, together with a prolongation of
the time taken to reach this maximum, and increased fatigue. The limitations
of grip strength as a measure of function of the hand are discussed.
|
|
Clinical and
electromyographical course of sciatica: prognostic study of 41 cases, Negrin
P, Fardin P.
|
Electromyogr Clin Neurophysiol 1987;27:125-127
Abstract: The study of the clinical and EMGraphical course
of patients with sciatica may help us to decide between a simple symptomatic
treatment and an admission to hospital for neuroradiological tests and
possible surgery. 41 patients with acute lumbosciatalgia and EMGraphically
proven monoradicular denervation were studied: the root affected was L5 in 39
cases (78%), L4 in 7 cases and S1 in 2 cases. 19 of these cases were then
submitted to surgical treatment of disc protrusion removal, the other 22 were
treated medically. 3 to 8 years later, the following parameters were tested:
pain, motor impairment, EMG denervation and degree of patient’s subjective
judgment. We concluded that urgent hospital admission is indicated only in
the case of severe and/or recent (within 1 month) paralysis or in the case of
intolerable painful symptomatology. The diagnostic and prognostic role of EMG
is hence confirmed: this examination yields information on the identity of
the root involved, the severity of the denervation, its course and the degree
of final improvement expected.
|
|
The use of
major and minor therapy forms in
Australian chiropractic practice, Leboeuf, C, Patrick, K.
|
Journal of the Australian
Chiropractic Association, 1987;17:109-11.
A survey of Australian chiropractors showed that most use five major
chiropractic techniques (Diversified, Sacro-Occipital technique, Gonstead,
Nimmo and Applied Kinesiology).
High velocity adjustive techniques
(Diversified and Gonstead) were the most commonly reported major core
techniques. Predominantly low velocity manual techniques such as Applied
Kinesiology, Sacro-Occipital technique and Nimmo were most commonly reported
as minor core techniques. Most employ adjunctive therapies, mainly nutrition,
extremity techniques and exercise.
|
|
The
relationship of knee and ankle weakness to falls in nursing home residents,
Whipple, R, Wolfson, L, Amerman, P.
|
J Am Geriatr Soc, 1987;35:329-32
A study of nursing home residents with a history of falling
found that muscle force and isokinetic power were significantly decreased in
knee flexors (quadriceps) and extensors (hamstrings), and ankle dorsiflexors
(tibialis anterior) and plantar flexors (gastrocnemius and soleus).
Dorsiflexors were particularly weak in fallers, suggesting that they are an
important factor contributing to balance. Of particular interest was ankle
flexor and extensor strength because these muscles are linked to balance
impairment in older adults with a history of falling. Strength training and
other treatments that may improve muscle function in these areas may enhance
balance in balance-impaired older adults.
|
|
Piriformis
syndrome: pathogenesis, diagnosis, and treatment, Steiner C, Staubs C, Ganon
M, Buhlinger C.
|
J Am Osteopath Assoc 1987;87:318-323
The failure of conservative treatment for lumbosacral disk
disorders often leads to surgery. If the pain is produced by sciatic neuritis
rather than sciatic radiculitis, operative treatment may be unavailing. This
paper describes the mechanism by which piriformis syndrome causes sciatic
neuritis and differentiates neuritis from radiculitis, the treatment of which
often results in the “failed disk syndrome.” Sciatic neuritis is now believed
to result from irritation of the sciatic nerve sheath, which is caused by
biochemical agents released from an inflamed piriformis muscle where the two
structures meet at the greater sciatic foramen. The symptoms of piriformis
syndrome present almost identically to lumbar disk syndrome, except for the
consistent absence of true neurologic findings. Diagnosis is accomplished by
palpation of myofascial trigger points within the piriformis muscle. Computed
tomography, myelography, roentgenography, and electromyography are of limited
diagnostic value. Treatment, which consists of a conservative approach
employing local anesthetics and osteopathic manipulation, is without
significant risk. Reducing muscle spasm, restoring joint motion, and keeping
the patient ambulatory and in motion are keys to successful treatment.
|
|
Correlation
of objective measure of trunk motion and muscle function with low-back disability
ratings, Triano, J, Schultz, A
|
Spine, 1987;12:561-5.
Abstract:
A study was undertaken to examine relations among some objective and
subjective measures of low-back-related disability in a group of 41 low-back
pain patients and in seven pain-free control subjects. Subjective measures of
disability were obtained by Oswestry patient questionnaires. Oswestry
disability score related significantly (P less than 0.001) to presence or
absence of relaxation in back muscles during flexion. Mean trunk strength
ratios were inversely related to disability score (P less than .05), and
trunk mobility was meaningfully reduced (P less than .01). Despite loss of
motion, a large enough excursion was observed to predict presence of back
muscle relaxation. These findings imply that myoelectric signal levels, trunk
strength ratios, and ranges of trunk motion may be used as objective
indicators of low-back pain disability.
Comment: The findings in this study
imply that muscle function, as measured by EMG, MMT, and ranges of trunk
motion may be used as objective indicators of low-back pain disability.
|
|
Clinical
biomechanical correlates for cervical function: Part II. A myoelectric study,
Vorro J, Johnston W.
|
J Am Osteopath Assoc 1987;87:353-367
Part 1 of this study compared cervical motion ranges for two
groups of human subjects classified as symmetric or asymmetric on the basis
of a single clinical test for cervical sidebending. Data from the asymmetric
group revealed limited mobility in all primary rotations and in secondary
deviations. Part 2 reports on the concurrent, bilateral measurement of
electromyographic activity for 12 selected muscle sites during the movements
executed. Data revealed that muscles in the asymmetric group were slower to
initiate action and were reduced in time and strength of contraction. Because
muscles provide the motive forces for the reduction in range previously
reported, these myoelectric data expand understanding of the disturbance in
physiologic function that is indicated when a clinical test for response to
motion in a spinal region is positive for asymmetry.
|
|
The relationship of injuries of the leg, foot, and
ankle to proximal thigh strength in athletes, Nicholas JA, Marino M.
|
Foot Ankle. 1987
Feb;7(4):218-28
Abstract:
Rehabilitation programs designed to restore leg, ankle, and foot function
following injury frequently ignore the proximal muscles. During athletics,
these knee, hip, and trunk muscles derive much of their functional power from
the foot and ankle. They also serve to integrate distal segment motions into
a total movement pattern such as jumping, running, or kicking. The linkage
system, which is a theoretical concept, describes the normal biomechanical
and physiological interactions between proximal and distal musculoskeletal
structures. Immobilization or injury of distal segments interrupts the normal
generation, summation, and transmission of muscular forces across joints.
Adequate measures must be taken to properly assess proximal structures for
weakness and tightness and to prescribe specific exercises to prevent the
migration of the effects of injury away from the involved segment.
Comment: In AK
examination and treatment, the “linkage system” is appreciated. The leg,
foot, and ankle are part of a complex system that links the foot and leg and
their related muscle attachments and other soft tissues, and neurologic and
vascular components, to the rest of the neuromusculoskeletal system The use
of AK methods, especially challenge and therapy localization, greatly assists
the practitioner in finding concealed or hidden linkages between problems in
the foot and leg and other muscular problems throughout the body.
|
|
The
craniocervical junction and disturbance of equilibrium, Lewit K.
|
Manuelle Medizine. 1986;24:26-9
Abstract: A random group of 106 patients affected by
pain due to functional disturbances in the spinal column with no symptoms of
vertigo were examined using the two-scales test and Hautant’s test in various
head and neck positions. The sample was divided into two groups: one had a
difference of more than 4 kg on both scales, and one a difference of up to 4
kg. It was shown that: (1) all patients with a difference of more than 4 kg
showed a cervical pattern when examined by the (modified) Hautant’s test and
in patients with a difference below 4 kg this was found in only 5 cases; (2)
a cervical pattern therefore existed in 55 (52%) of a random group with
vertebrogenic disturbances; (3) the greatest difference in both groups was in
the incidence of movement restriction in the craniocervical junction. This
was absent in the first group in only 5 patients, and in 35 in the second.
The cervical pattern was closely correlated with nystagmus in the extreme
position when examined using Frenzel’s spectacles. Immediately after
treatment, the cervical pattern (Hautant’s test) was usually normalized;
frequently (in about half the cases) we obtained normal results on both
scales; nystagmus in the extreme position examined with Frenzel’s spectacles
usually remained positive. The dominating influence of the craniocervical
junction for human equilibrium is stressed; disturbance of the equilibrium is
much more frequent without vertigo (dizziness) than with. The term “latent vertigo” is suggested for the
former. In this disturbance the motor system plays a decisive role.
Equilibrium can therefore be defined as a function of the motor system
subserving posture in the field of gravity.
|
|
Contractile
changes in opposing muscles of the human ankle join with aging, Vandervoort,
A, McComas, A.
|
J Appl Physiol, 1986;61:361-7
This article demonstrates that strength declines approximately
15% per decade between the ages of 50 and 70 years, and approximately 1.5%
per year after the age of 70 years, and decreases in strength are associated
with falling in elderly people.
|
|
Manual
muscle test scores and dynamometer test scores of knee extension strength,
Bohannon RW.
|
Arch Phys Med Rehabil. 1986 Jun;67(6):390-2.
The knee extension force of 50 patients was investigated using
traditional manual muscle testing and hand-held dynamometry. The relationship
between manual muscle test word scores and dynamometer force scores was
determined using Kendall tau, as was the relationship between manual muscle
test percentage scores and dynamometer scores expressed as a percentage of
"normal." Percentage scores were also compared to determine if a
significant difference existed. Manual muscle test scores and dynamometer
test scores were significantly correlated (p less than .001). Percentage
manual muscle test and dynamometer test scores were significantly different
(p less than .001). These results suggest that the two procedures measure the
same variable-strength. Manual muscle test percentage scores of knee
extension may, however, overestimate the extent to which a patient is "normal."
|
|
Predictive value of manual muscle testing and gait
analysis in normal ankles by dynamic electromyography, Perry, J.P. et al
|
Foot Ankle. 1986
Apr;6(5):254-9.
Eight muscles about the ankle of seven normal subjects were
assessed by electromyography (EMG) during manual muscle testing (MMT) and
walking. Three strength levels (normal, fair, trace) and three gait
velocities (free, fast, slow) were tested. The muscles studied included the
gastrocnemius, soleus, posterior tibialis, flexor digitorum longus, flexor
hallucis longus, anterior tibialis, extensor digitorum longus, and extensor
hallucis longus. Relative intensity of muscle action was quantitated visually
(using an eight-point scale based on amplitude and density of the signal).
The data showed that EMG activity increased directly as more muscle force was
required during the different manual muscle test levels and increased walking
speeds. No MMT isolated activity to the specific muscle though being tested.
Instead, there always was a synergistic response. Both the gastrocnemius and
soleus contributed significantly to plantarflexion regardless of knee
position. The intensity of muscle action during walking related to the manual
muscle test grades. Walking at the normal free velocity (meters/min) required
fair (grade 3) muscle action. During slow gait the muscle functioned at a
poor (grade 2) level. Fast walking necessitated muscle action midway between
fair and normal, which was interpreted as good (grade 4).
|
|
Reliability of lumbar
paravertebral EMG assessment in chronic low back pain, Ahern DK,
Follick MJ, Council JR, Laser-Wolston N.
|
Arch Phys Med Rehabil. 1986
Oct;67(10):762-5.
Abstract: The reliability of lumbar
paravertebral EMG assessment was investigated in a sample of 70 patients with
chronic low back pain, (CLBP). Dual-site EMG monitoring was employed during
both static postures and movements. Flexion and rotation indices were divided
to assess the reliability of patterning of paravertebral EMG during movement.
Within-session reliabilities computed for the full sample ranged from 0.66 to
0.97, and between-session reliabilities, computed on a subset of 29 patients
retested after varying intervals, ranged from 0.26 to 0.92. Average EMG
levels, flexion, and rotation indices showed no statistically significant
differences between surgical (n = 40) and nonsurgical patients (n = 30),
although EMG variability was consistently greater for surgical patients
across the postures and movements. These
results indicate that lumbar paravertebral EMG can be reliably measured and
therefore has potential utility as an assessment and treatment variable in
CLBP.
|
|
Muscle dysfunction in male hypogonadism, Chauhan AK, Katiyar BC, Misra S, Thacker
AK, Singh NK.
|
Acta
Neurol Scand. 1986 May;73(5):466-71.
Abstract: Twenty-eight
consecutive male patients with primary and secondary hypogonadism (14 each)
were evaluated clinically and electrophysiologically for muscle dysfunction.
Although generalised muscle weakness was initially reported by only 9
patients, on direct questioning, it was recorded in 19. Objective weakness
was found in 13 patients and it involved both the proximal and distal limb
muscles. Quantitative electromyography showed evidence of myopathy in the
proximal muscle in 25 patients, i.e., reduced MUP duration and amplitude with
increased polyphasia in the deltoid and the gluteus maximus. There were no
denervation potentials. None of the patients showed clinical neuropathy or
NCV abnormalities. Thus, the profile of
muscle involvement in hypogonadism closely simulates limb-girdle muscular
dystrophy and other endocrine myopathies. The incidence of muscle involvement
was higher in secondary hypogonadism. Diminished androgens in primary
hypogonadism and diminished growth hormone in the secondary hypogonadism are probably
responsible for the myopathy.
Comment: This paper
demonstrates what has been demonstrated clinically in AK for many years,
namely that endocrine disturbances may often be reflected in muscle
dysfunction.
|
|
Reflex inhibition of the
quadriceps after meniscectomy: lack of association with pain,
Shakespeare DT, Stokes M, Sherman KP, Young A.
|
Clin Physiol. 1985
Apr;5(2):137-44.
Abstract: We have examined the
severity and duration of reflex inhibition of quadriceps activation after
arthrotomy and meniscectomy, its relationship with pain, and the effect of
local anesthesia on this relationship. Fourteen men, on completion of medial
meniscectomy by arthrotomy, received either 10 ml (B10 group) or 15 ml (B15
group) of 0.5% bupivacaine hydrochloride ('Marcaine Plain') into the knee, or
no injection (control group). Reflex inhibition of quadriceps was measured as
the percentage reduction, from the ipsilateral preoperative value, in the
integrated surface electromyogram recorded during maximal voluntary isometric
contractions with the knee in extension. Pain during each contraction was
recorded on a linear analogue scale. Unoperated limbs showed no evidence of
quadriceps inhibition. In the operated limbs, at 1-2 h post-operatively,
controls had both severe inhibition (median = 62%) and severe pain on
attempting a maximal quadriceps contraction. The B10 group had similar
inhibition but less pain (P less than or equal to 0.005, Wilcoxon 2-sample,
1-tailed test). In the B15 group both inhibition (P less than or equal to
0.05) and pain (P less than or equal to 0.01) were less than in the controls.
These effects of bupivacaine had been lost by 4-5 h post-operatively. At 3-4
days, inhibition was still severe (median = 75%) in all three groups of
patients but pain was only mild or absent. At 10-15 days, median inhibition
was still 35%, but there was little or no pain. We conclude that
postmeniscectomy inhibition is not simply due to perceived pain but is due,
at least in part, to stimuli from the knee.
|
|
Quantification of lumbar function. Part 2: Sagittal
plane trunk strength in chronic low-back pain patients, Mayer TG,
Smith SS, Keeley J, Mooney
V.
|
Spine. 1985 Oct;10(8):765-72.
Abstract: A prototype
sagittal plane trunk strength tester was used to measure trunk strength in 286
chronic low-back pain patients. Initial data for this patient group are
compared with data acquired previously from a group of controls, adjusted for
age, sex, and body weight. Distinct
patterns characterize the patient sample as opposed to the controls: Patient
values for both flexors and extensors were markedly decreased, with greater
variability; Extensor strength was affected more significantly than flexor
strength; Discrepancies between patients and controls were greater for
females than for males; High-speed dropoff ratios were much lower
for patients, both in flexion and extension. These results demonstrate that strength deficits are a major factor in
the deconditioning syndrome associated with chronic low-back pain.
Comment:
To test
the construct validity of the AK hypothesis that muscle weakness instead of
muscle spasm was the cause of spinal pain and dysfunction, researchers have
attempted to quantify the muscle weakness that occurs with specific clinical
conditions such as low back pain. This paper very elegantly demonstrates one
of the prime contentions of AK.
|
|
Clinical trials in Duchenne dystrophy.
Standardization and reliability of evaluation procedures, Florence JM, Pandya S, King WM, Robison JD,
Signore LC, Wentzell M, Province MA.
|
Phys
Ther. 1984 Jan;64(1):41-5.
Abstract: A
multiclinic, collaborative study has been designed to assess the natural
progression and efficacy of treatment of Duchenne muscular dystrophy. This
article describes the protocol for the evaluation technique and the method
used to establish within (intraobserver) and between (interobserver)
reliability of the protocol evaluation procedures. Standardized patient
evaluations were used, and consistency of evaluation was monitored by a
computer. The reliability of the measures was analyzed 1) within observers by
comparing the results of each of the first three tests done by each evaluator
for all patients and 2) between observers by comparing, at multicenter group
meetings, the results of each of the four evaluators' tests of the same
patient. We have demonstrated reliability for an evaluation method that will
provide an objective foundation on which to claim a drug or therapeutic
procedure does or does not have an effect in treating Duchenne muscular
dystrophy.
Comment: This paper
showed that there was significant improvement in the degree of consistency of
a given examiner’s MMT scores when the examiner had more clinical experience
and training in MMT. Many other researchers of MMT have discussed the
importance of considering the examiner’s training upon the outcomes of
studies that assess strength via MMT.
|
|
Physical
measurements as risk indicators for low back trouble over a one year period,
Biering-Sorensen, F.
|
Spine,
1984;9:106-19
Abstract: Of all 30-,
40-, 50-, and 60-year-old inhabitants of Glostrup, a suburb of Copenhagen,
82% (449 men and 479 women) participated in a general health survey, which
included a thorough physical examination relating to the lower back. The
examination was constituted of anthropometric measurements,
flexibility/elasticity measurements of the back and hamstrings, as well as
tests for trunk muscle strength and endurance. The reproducibility of the
tests was found to be satisfactory. Twelve months after the physical
examination 99% of the participants completed a questionnaire sent by mail
concerning low back trouble (LBT) in the intervening period. The prognostic
value of the physical measurements was evaluated for first-time experience
and for recurrence or persistence of LBT by analyses of the separate
measurements and discriminant analyses. The main findings were that good
isometric endurance of the back muscles may prevent first-time occurrence of
LBT in men and that men with hypermobile backs are more liable to contract
LBT. Recurrence or persistence of LBT was correlated primarily to the
interval since last LBT-episode: the more LBT, the shorter the intervals had
been. Weak trunk muscles and reduced flexibility/elasticity of the back and
hamstrings were found as residual signs, in particular, among those with
recurrence or persistence of LBT in the follow-up year.
|
|
Knee joint effusion and quadriceps reflex inhibition in man, Spencer JD, Hayes KC, Alexander IJ.
|
Arch Phys Med Rehabil.
1984 Apr;65(4):171-7.
Abstract: This study
was designed to elucidate the role of effusion in producing the reflex
inhibition, and subsequent atrophy, of quadriceps musculature following knee
trauma. In particular, consideration was given to determining the extent,
threshold and linearity of inhibition of the motoneuron pool induced by
experimental introduction of small increments of 0.9% physiological saline
(up to 60ml) into the joint space of the knee in ten healthy subjects.
Inhibition of the quadriceps muscle motoneuron pool was indirectly assessed
through recording Hoffmann (H) reflexes evoked from vastus medialis,
lateralis and rectus femoris. All ten subjects showed a significant (p less
than 0.05) reduction in H-reflex amplitude following the introduction of
saline: vastus medialis reduced to 55.7 +/- 4.3% of its control 0ml value,
rectus femoris to 69.1 +/- 6.1% and vastus lateralis to 65.3 +/- 4.0%. Post
hoc analyses of the H-reflex amplitudes at each increment of simulated
effusion revealed the threshold for reflex inhibition of the vastus medialis
to be between 20 and 30ml of saline and for rectus femoris and vastus
lateralis to be between 50 and 60ml. These procedures were repeated on eight
subjects following an injection of the anesthetic lidocaine (1%) to the
intra-articular space of their knee joints but there was no significant
reduction in H-reflex amplitude. Linear relationships were found to
adequately describe the relationships between the volume of effusion and
intra-articular pressure; and volume of effusion and reduction in H-reflex
amplitude.
Comment: This paper
shows that experimentally induced noninflammatory effusions in the knees of
10 human subjects produced a significant reflexly induced inhibition of the
alpha-motoneuron pool of the quadriceps muscles in the absence of pain, joint
damage, trauma or movement.Furthermore,
they state that the reflex inhibition is blocked by intra-articular
anesthesia. They conclude that the inhibition is neurologically mediated in
response to changes in articular mechanoreceptive input. Altered muscle tone
and mobility are consistently found in AK examination in response to changes
of articular or periarticular afferent input.
|
|
Musculoskeletal performance testing and profiling of
elite competitive fencers, Sapega AA, Minkoff J, Valsamis M,
Nicholas JA.
|
Clin Sports
Med. 1984 Jan;3(1):231-44.
Abstract: Twenty-four
male members of the 1976 United States Olympic Fencing Squad were profiled. Data were collected on anthropometry; flexibility;
and muscular strength, endurance, and power. Five of the physical variables
measured in the laboratory were shown to have a significant relationship to
competitive success.
|
|
Myofascial origins of low back pain. 1. Principles of diagnosis and
treatment, Simons DG, Travell JG.
|
Postgrad Med. 1983
Feb;73(2):66, 68-70, 73 passim.
Abstract: Myofascial
trigger points (TPs) are frequently overlooked sources of acute and chronic
low back pain. An active myofascial TP is suspected by its focal tenderness
to palpation and by restricted stretch range of motion. The restricted
lengthening of the muscle is due to the tense band of muscle fibers in which
the TP is located. The presence of a TP is confirmed by a local twitch
response and by reproduction of its known pattern of referred pain, which
matches the distribution of the patient's pain. Only an active TP causes a
clinical pain complaint; a latent TP does not. The pain can be relieved by
the stretch-and-spray procedure, ischemic compression, or precise injection
of the TP with procaine solution. Relief is usually long lasting only if mechanical
and systemic perpetuating factors are corrected.
Comment: The work of
Dr. Janet Travell has influenced allopathic and complimentary and alternative
medicine and is one of the foundations of AK.
|
|
Myofascial origins of low back pain. 2. Torso muscles,
Simons DG, Travell JG.
|
Postgrad Med.
1983 Feb;73(2):81-92.
Abstract:
Trigger points (TPs) in muscles of the lower torso associated with
the spine are an important cause of low back pain. The quadratus lumborum is
the muscle most commonly involved, but TPs located there are often overlooked
because of inadequate physical examination techniques. TPs in the lower
rectus abdominis refer pain horizontally across the low back, and those in
the iliopsoas refer pain in a vertical pattern, parallel to the lumbosacral
spine. The pain pattern of TPs in the serratus posterior inferior is noted in
the region of the muscle itself.
|
|
Myofascial origins of low back pain. 3. Pelvic and lower extremity
muscles,
Simons DG, Travell JG.
|
Postgrad Med.
1983 Feb;73(2):99-105, 108.
Abstract:
Gluteal, pelvic, and lower extremity muscles are common sites of
origin of myofascial low back pain. Trigger points (TPs) in the gluteus
maximus and medius muscles refer pain locally to the gluteal and sacral
regions, while those in the gluteus minimus are likely to refer pain down the
lower extremity as far as the ankle on the same side. TPs in intrapelvic
muscles refer pain chiefly to the pelvic region. Besides producing referred
myofascial pain, TPs in the piriformis muscle can cause symptoms of
entrapment of the peroneal portion or all of the sciatic nerve. TPs in the
soleus muscle may refer pain to the sacroiliac joint.
|
|
Effects of
manipulation on gait muscle activity: preliminary electromyographic research,
Hibbard D.
|
J Am
Chiro Assoc 1983;17:49-51
This study analyzed the effect of chiropractic manipulation of the extremities on gait muscles. |
|
The efficacy
of manual assessment of muscle strength using a new device, Marino M,
Nicholas JA, Gleim GW, Rosenthal P, Nicholas SJ.
|
Am J
Sports Med. 1982 Nov-Dec;10(6):360-4
Abstract: The purpose of
this study was to compare the manual assessment of muscle strength with a
small, handheld (by the examiner) force-measuring device developed by the
Institute of Sports Medicine and Athletic Trauma (ISMAT). One hundred
twenty-eight patients presented with a known lower extremity orthopaedic
pathology. All patients were clinically evaluated for hip abductor and hip
flexor weakness in standard positions using the "break test"
technique. All 128 patients were then evaluated with the ISMAT Manual Muscle
Tester, a small, hand-held device which recorded the peak force (kg) required
to break a muscle contraction. Three bilateral measures of hip abduction and
hip flexion were recorded, averaged, and compared to the subjective clinical
evaluation using a chisquare analysis. Bilateral
values which were within 5% of each other were not considered significant and
therefore not included in the calculations. The average hip abduction and hip
flexion scores measured by the ISMAT tester were consistent with the
examiner's perception of muscle weakness (P less than 0.001). The results
demonstrate consistent detection of muscle weakness by the ISMAT Manual
Muscle tester over a broad range of testing conditions.
Comment: The MMTs employed
in this study used the standard positions delineated by Kendall and Kendall
and the ones used in AK, specifically for the rectus femoris and gluteus
medius muscles.
|
|
Electromyographic
analysis following chiropractic manipulation of the cervical spine: a model
to study manipulation-induced peripheral muscle changes, Rebechini-Zasadny H,
Tasharski C, Heinze, W.
|
J
Manipulative Physiol Ther 1981;4:61-63
This study
showed the effects of chiropractic manipulation upon the musculature of 12
volunteers, specifically an increase in finger strength after cervical
adjusting.
|
|
Investigation of over-the-skin electrical
stimulation parameters for different normal muscles and subjects, Moreno-Aranda J, Seireg A.
|
J
Biomech. 1981;14(9):587-93
This study demonstrates a small part of the potentiality of the AK technique called Therapy Localization or TL. |
|
Usefulness
of electrophysiological studies in the diagnosis of lumbosacral root disease,
Tonzola R, Ackil A, Shahani B, Young R.
|
Ann
Neurol 1981;9:305-308
Abstract: Clinical,
electrophysiological, and myelographic findings were correlated in 57
patients with the clinical diagnosis of lumbosacral root disease.
Conventional motor and sensory (including sural nerve) conduction studies
were normal in all patients. Electromyography, late response studies in
different muscles of the lower extremity, the myelogram, or combinations of
these tests were abnormal in 44 patients (77%). Of 36 patients (63%) with
abnormal myelograms, 14 had normal electrophysiological studies. Twenty-nine
(51%) had an abnormal electrophysiological or myelographic finding; although
8 patients in this group had a normal myelogram, 2 had an abnormal discogram
and 1 an abnormal epidurogram. Electrophysiological or myelographic findings,
in some cases both, correlated well with clinical signs and symptoms in 41
patients (72%). H-reflex and F response studies, when abnormal, helped in
localizing a lesion in the appropriate root distribution.
Comment: This study
demonstrates that EMG shows better correlation with neurological examinations
than CT scans or myelograms for nerve root disturbances in the lumbosacral
spine. In other words, muscle dysfunction correlates better with lumbosacral
nerve root injuries than CT scans or myelograms.
|
|
Trunk strengths in attempted flexion, extension, and
lateral bending in healthy subjects and patients with low-back disorders, McNeill T, Warwick D, Andersson G, Schultz
A.
|
Spine. 1980 Nov-Dec;5(6):529-38.
Abstract: Trunk
strengths were measured in 27 health males and 30 health females, and in 25
male and 15 female patients with low-back pain and/or sciatica. Maximum
voluntary isometric strengths were measured during attempted flexion,
extension, and lateral bending from an upright standing position. Both male
and female patients had approximately 60% of the absolute trunk strengths of
the corresponding healthy subjects. Intra-individual trunk strength ratios
were used to interpret the results. Use of these ratios tends to avoid
interpretational problems created by the general weakness of the patients and
any lack of motivation of either patients or healthy subjects. The ratios
showed that the patients had attempted extension strengths that were
significantly less than their strengths in the other types of movements
tested. The strength ratios for attempted extension were particularly low for
patients with sciatica.
|
|
Trunk strengths in patients seeking hospitalization
for chronic low-back disorders, Addison R, Schultz A.
|
Spine. 1980 Nov-Dec;5(6):539-44.
Abstract: Trunk strengths
of 16 male and 17 female patients with chronic low-back disorders were
measured. The patients sought hospitalization for four weeks in a pain
clinic. Maximum voluntary trunk strengths in the standing position were
measured during attempted flexion, extension, and lateral bending. The trunk
strengths of these patients were then compared with those of health subjects
and with those of patients with low-back disorders who sought treatment as
outpatients of a general orthopaedic office practice. In making the
comparisons, intra-individual trunk-strength ratios were used to overcome
problems due to the effects of patients' general weakness and any psychologic
factors. When compared with healthy
subjects, the patients seeking hospitalization had significantly smaller
strengths during attempted extension relative to their strengths during
attempted flexion or lateral bending. Their trunk-strength ratios
did not differ significantly from those of the outpatient group.
|
|
Back and leg complaints in relation to muscle
strength in young men, Karvonen
MJ, Viitasalo JT, Komi PV, Nummi J, Jarvinen T.
|
Scand J
Rehabil Med. 1980;12(2):53-9.
Abstract: Back and leg
complaints were studied by using a questionnaire and medical examination in
183 male conscripts and relating the results to background variables,
anthropometry, the isometric strength of large muscle groups, and endurance
running. A history of sciatica was reported by 8%, lumbago by 13%, back
injury by 13% and low back insufficiency by 63%. Weak trunk extensors were
associated with a history of sciatica, weak trunk flexors with back injuries
and with current backache at work/exercise. Weak leg extensors showed
associations with a history of low back insufficiency and of sick leave due
to the back and with current hip pain. Men with a history of lumbago and of
hip and knee complaints performed poorly during 12 min of running. Back and
leg complaints were more frequent in men with high socio-economic status, who
engaged in little physical activity, or who were obese. The questionnaire and
strength measurements proved suitable for studying low back syndrome in its
early stages.
|
|
The
Application of Neurological Reflexes to the Treatment of Hypertension,
Mannino, R.
|
Journal of the American
Osteopathic Association, Dec 1979:225-230
|
|
Factors influencing manual muscle tests in physical
therapy, Nicholas JA,
Sapega A, Kraus H, Webb JN.
|
J Bone
Joint Surg Am. 1978 Mar;60(2):186-90
Abstract: To determine
whether it is the amount or the duration of the force applied manually by the
tester, or both, that determines the tester's perception of the strength of
the hip flexor or abductor muscles, an electromechanical device was designed
which was placed between the tester's hand and the subject's limb. With the
device we measured the force applied to the limb, the time interval during
which it was applied, and the angular position of the limb during the entire
test. In 240 such tests, the testers' ratings of the differences in strength
between the right and left sides were correlated with seven variables
involving force and time. It was found statistically that the impluse--that
is, the duration of the tester's effort multiplied by the average applied
force during each test--was the factor that most influenced the tester in the
ratings.
Comment: The skills of
the examiner related to conducting tests and interpreting the derived
information will affect the usefulness of muscle performance data.The examiner is obliged to follow a
standardized protocol that specifies patient position, verbal instructions or
demonstration to the patient, alignment of the muscle and direction of
examiner resistance to insure precise, repeatable, and reliable MMT results.
When a
muscle is tested in voluntary isometric contraction, EMG testing reveals that
additional muscle fibers contract at low forces; when the force increases,
the rate of firing becomes the predominant mechanism to increase strength.
Tension, velocity, and electrical activity are interdependent and indicate
the importance of proper neurologic control for the muscle to meet the
changing pressure demands of the MMT. This requires effective function of the
gamma system adjusting the neuromuscular spindle cell, and proper
interpretation of its afferent supply by the central nervous system. Thus it is
patient or more precisely the patient’s neuromuscular adaptive capacity that
is being examined during a proper MMT.
|
|
Muscular
Strength Correlated to Jaw Posture and the Temporomandibular Joint –
Examination of a Professional Football Population, Smith, S.D.
|
New York State Dental Journal, 44(7);Aug/Sept
1978
|
|
The use of skin stimulation to produce reversal of
motor unit recruitment order during voluntary muscle contraction in man
[proceedings], Buller
NP, Garnett R, Stephens JA.
|
J
Physiol. 1978 Apr;277:1P-2P.
This paper
demonstrates the specific effect of skin stimulation upon muscle function,
and shows the neurological relationships that may be occurring during the
therapy localization procedure in AK diagnosis and treatment.
|
|
Reversal of recruitment order of single motor units
produced by cutaneous stimulation during voluntary muscle contraction in man,
Stephens JA, Garnett R,
Buller NP.
|
Nature. 1978 Mar
23;272(5651):362-4.
This paper demonstrates
the specific effect of skin stimulation upon muscle function, and shows the
neurological relationships that may be occurring during the therapy
localization procedure in AK diagnosis and treatment.
|
|
Discogenic
radiculopathy: use of electromyography in multidisciplinary management, Lane
M, Tamhankar M, Demopoulos J.
|
NY State J Med 1978;78:32-36
This study demonstrated an 85% agreement between EMG evaluation and
neurological work-up, evidencing nerve root compromise. There is evidence
offered that EMG readings may be equivalent to subluxation determination.
This study shows that changes in muscle electrical activity measured in
distinct myotomes revealed nerve root disturbance. The study concludes that a
positive EMG finding, indicating the presence of a lesion at the level of the
root or proximal in the spinal cord, should alert the clinician.
|
|
A study of thigh muscle weakness in different
pathological states of the lower extremity, Nicholas JA, Strizak AM, Veras G.
|
Am J Sports Med. 1976
Nov-Dec;4(6):241-8.
|
|
Grip strength and chiropractic adjustment, Howitt
Wilson MB.
|
Anglo-European College of Chiropractic, 1975.
Abstract:
Six student controls and 50 patients had their grip strength measured with a
sphygmomanometer after CMT to the T1 vertebra. 21 patients had significant
contralateral grip strength increases.
|
|
Towards
standardization of muscle strength testing, Kroemer KH, Howard JM.
|
Med Sci
Sports. 1970 Winter;2(4):224-30
Abstract:
Male subjects (N=24) exerted maximal horizontal forces either trying to
maintain a constant level over 5 seconds, or increasing steadily to the
subjective maximum, or in vigorous jerks of the body. Statistical analysis
(p<0.01) indicated that these different techniques of force generation can
result in different peak impulses. For the force maintained over 5 seconds,
different scores (peak, and 12 averages during the exertion period) were
extracted from the recorded force curves. Many of the resulting scores were
significantly different from the others. Thus, a number of distinctly
different “strength” scores resulted either from techniques of force
generation used by the subjects, or from different statistical treatments of
the same raw data by the experimenter. To standardize measures of “strength,”
a definition of strength, a checklist to control experimental techniques, and
a regimen to calculate the strength index are proposed.
|
|
Dysponesis: a neurophysiologic factor in functional
disorders,
Whatmore GB, Kohi DR.
|
Behav
Sci. 1968 Mar;13(2):102-24.
Abstract:
Dysponesis is described as a reversible patho-physiologic state consisting of
unnoticed, misdirected neurophysiologic reactions to various agents
(environmental agents, body sensations, emotions and thoughts) and the
repercussions of these reactions throughout the organism.
Comment: In
AK it is proposed that these errors in energy expenditure, potentially
capable of producing functional disorders, consist mainly of covert errors in
action potential output from the motor and premotor areas of the cerebral
cortex and include the consequences of that output. These neurophysiologic events
result in aberrant muscle activity that may be evaluated through manual
muscle testing technique.
|
|
Cord cells responding to fine myelinated afferents
from viscera, muscle and skin,
Pomeranz B, Wall PD, Weber WV.
|
J Physiol. 1968
December; 199(3): 511–532.
Abstract: 1.
Micro-electrode recordings were made in the thoracic cord of acute spinal
cats. Cells, which were located in the
histologically defined lamina 5, responded both to the fine myelinated
afferents from the splanchnic nerve and to afferents from the skin.
Splanchnic afferents inhibit the effect of converging cutaneous inputs for
periods up to 150 msec. Skin stimuli may also inhibit the effect of afferent
nerve impulses from viscera. Some cells respond monosynaptically to the
splanchnic afferents, others indirectly.
2. Fine myelinated
afferents from gastrocnemius (group 3) stimulate lamina 5 cells which also
have cutaneous receptive fields. Cutaneous and group 3 muscle afferents
interact by mutual inhibition in their effect on the cells.
3. Fine myelinated
afferents from skin excite lamina 5 cells. The cutaneous responses of lamina
5 cells contrast with those of lamina 4 cells in the following respects: (a) the receptive fields are
larger, (b) they respond
with an increased latency to Aβ afferents, (c) there is a low pressure threshold at the edge, (d) they respond to a wide range of pressure stimuli from light brush to
heavy pinch applied to the centre of the receptive fields and (e) they respond to A
afferents.
4. Lamina 5 cells receive fine myelinated afferents
either from viscera or from muscle or from skin. Lamina 4 receives
large myelinated afferents from skin and lamina 6 receives large myelinated
afferents from muscle. The results suggest
the hypothesis that some fine myelinated afferents form a class of afferents
which signal the state of tissue, and end on lamina 5 cells.
Comment: This early
paper describes the neurology involved in the AK testing method called
Therapy Localization. In AK, TL is a simple, non-invasive technique to find
out where a problem in the body exists. TL doesn’t show the physician what
the problem is but shows that something under the hand that is contacting the
patient’s body is disturbing the nervous system.
|
|
An
Introduction to Chapman’s Reflexes, Chaitow, L.
|
British Naturopathic Journal,
Spring 1965
|
|
Muscle
testing. Part 2:Reliability in clinical use, Iddings DM, Smith LK, Spencer
WA.
|
Phys Ther Rev 1961;41:249-256.
|
|
Quantitative
muscle testing: Principles and applications to research and clinical
services, Beasley W
|
Arch Phys Med Rehabil 1961;42:398-425
|
|
Study of the
reproducibility of muscle testing and certain other aspects of muscle
scoring, Lilienfeld AM, Jacobs M, Willis M.
|
Phys Ther Rev 1961;41:249-256.
|
|
Excitatory and inhibitory skin areas for flexor and
extensor motoneurons, Hagbarth
KE.
|
Acta
Physiol Scand Suppl. 1952;26(94):1-58.
Comment: This early
paper describes some of the neurology involved in the AK testing method
called Therapy Localization. In AK, TL is a simple, non-invasive technique to
find out where a problem in the body exists. TL doesn’t show the physician
what the problem is but shows that something under the hand that is
contacting the patient’s body is disturbing the nervous system.
|
|
Some
interesting observations about the after care of infantile paralysis
patients, Kendall HO
|
J Excep Child 1936;3:107.
|
|
A method of
recording muscle tests, Lowman CL.
|
Am J Surg 1927;3:586-591.
Abstract: It has been
quite generally accepted that muscle reeducation, as applied particularly to
paralysis causes, is of very decided value in treatment. A grading system for
muscle measurement is delineated, ranging from 0 (no appreciable motion) to 9
(normal muscle strength and motion). Allowance must be made for the personal
equation which usually accounts for at least a variance of one degree between
examiners. Preferably the same persons should make all the tests, and the
longer they do this the more reliable they become.
|
|
Certain aspects of infantile paralysis with a
description
of a method of muscle testing, Lovett RW, Martin EG.
|
JAMA.1916 Mar 4;
LXVI(10):729-33.
|
|
A method of testing muscular strength in infantile
Paralysis, Martin EG, Lovett RW.
|
JAMA. 1915 Oct
30; LXV(18):1512-3.
|
|
Treatment of infantile paralysis, Lovett RW.
|
JAMA 1915;64:2118
|
Muscle training in the treatment of infantile paralysis,
Wright WG.
|
Boston Med Surg J 1912;167:567-574.
|
|
|