The Immediate Effects of Upper Thoracic Translatoric Spinal Manipulation on Cervical Pain and Range of Motion: A Randomized Clinical Trial

This study examined the effect of translatoric spinal manipulation (TSM) on cervical pain and cervical active motion restriction when applied to upper thoracic (T1-T4) segments. Active cervical rotation range of motion was measured re- and post-intervention with a cervical inclinometer (CROM), and cervical pain status was monitored before and after manipulation with a Faces Pain Scale. Study participants included a sample of convenience that included 32 patients referred to physical therapy with complaints of pain in the mid-cervical region and restricted active cervical rotation. Twenty-two patients were randomly assigned to the experimental group and ten were assigned to the control group. Pre- and post-intervention cervical range of motion and pain scale measurements were taken by a physical therapist assistant who was blinded to group assignment. The experimental group received TSM to hypomobile upper thoracic segments. The control group received no intervention. Paired t-tests were used to analyze within-group changes in cervical rotation and pain, and a 2-way repeated-measure ANOVA was used to analyze between-group differences in cervical rotation and pain. Significance was accepted at p = 0.05. Significant changes that exceeded the MDC₉₅ were detected for cervical rotation both within group and between groups with the TSM group demonstrating increased mean (SD) in right rotation of 8.23° (7.41°) and left rotation of 7.09° (5.83°). Pain levels perceived during post-intervention cervical rotation showed significant improvement during right rotation for patients experiencing pain during bilateral rotation only (p=.05). This study supports the hypothesis that spinal manipulation applied to the upper thoracic spine (T1-T4 motion segments) significantly increases cervical rotation ROM and may reduce cervical pain at end range rotation for patients experiencing pain during bilateral cervical rotation.     

Active range of motion in the cervical spine increases after spinal manipulation (toggle recoil)

BACKGROUND: It has generally been assumed that spinal manipulation has the biomechanical effect of increasing spinal range of motion. Past research has shown that there are likely no lasting changes to passive range of motion, and it is unclear whether there is an increase in active range of motion after manipulation. OBJECTIVE: To study changes in active cervical range of motion after spinal manipulation of the cervical spine. DESIGN: A double-blind randomized controlled trial at the outpatient clinic Phillip Chiropractic Research Centre, RMIT University, Melbourne, Australia. METHODS: One hundred five patients with cervicogenic headache were randomized into 2 groups. After a baseline observation period, Group 2 received manipulation (toggle recoil) to the cervical spine, whereas Group 1 received sham manipulation. In the next trial phase, Group 1 received manipulation, whereas Group 2 received no treatment. This was followed by the final trial phase, in which Group 2 received sham manipulation and Group 1 received no treatment. After each trial phase, active range of cervical motion was measured with a strap-on head goniometer by 2 blinded examiners. RESULTS: After receiving spinal manipulation, active range of motion in the cervical spine increased significantly (P < .0006) in Group 2 compared with Group 1, and this difference between the treatment groups disappeared after the third trial phase in which Group 1 also received manipulation, as expected. CONCLUSION: Spinal manipulation of the cervical spine increases active range of motion.     

Procedure Selection and Patient Positioning Influence Spine Kinematics During High-Velocity,Low-Amplitude Spinal Manipulation Applied to the Low Back

Objectives

This investigation compared indirect 3-dimensional angular kinematics (position, velocity, and acceleration) of the lumbar spine for 2 different high-velocity, low-amplitude (HVLA) spinal manipulation procedures (lumbar spinous pull or push), and altered initial patient lower limb posture.

A rigid body model of the dynamic posteroanterior motion response of the human lumbar spine

BACKGROUND: Clinicians apply posteroanterior (PA) forces to the spine for both mobility assessment and certain spinal mobilization and manipulation treatments. Commonly applied forces include low-frequency sinusoidal oscillations (<2 Hz) as used in mobilization, single haversine thrusts (<0.5 seconds) as imparted in high-velocity, low-amplitude (HVLA) manipulation, or very rapid impulsive thrusts (<5 ms) such as those delivered in mechanical-force, manually-assisted (MFMA) manipulation. Little is known about the mechanics of these procedures. Reliable methods are sought to obtain an adequate understanding of the force-induced displacement response of the lumbar spine to PA forces. OBJECTIVE: The objective of this study was to investigate the kinematic response of the lumbar spine to static and dynamic PA forces. DESIGN: A 2-dimensional modal analysis was performed to predict the dynamic motion response of the lumbar spine. METHODS: A 5-degree-of-freedom, lumped equivalent model was developed to predict the PA motion of the lumbar spine. Lumbar vertebrae were modeled as masses, massless-spring, and dampers, and the resulting equations of motion were solved by using a modal analysis approach. The sensitivity of the model to variations in the spring stiffness and damping coefficients was examined, and the model validity was determined by comparing the results to oscillatory and impulsive force measurements of vertebral motion associated with spine mobilization and 2 forms of spinal manipulation. RESULTS: Model predictions, based on a damping ratio of 0.15 (moderate damping) and PA spring stiffness coefficient ranging from 25 to 60 kN/m, showed good agreement with in vivo human studies. Quasi-static and low-frequency (<2.0 Hz) forces at L3 produced L3 segmental and L3-L4 intersegmental displacements up to 8.1 mm and 3.0 mm, respectively. PA oscillatory motions were over 2.5-fold greater for oscillatory forces applied at the natural frequency. Impulsive forces produced much lower segmental displacements in comparison to static and oscillatory forces. Differences in intersegmental displacements resulting from impulsive, static, and oscillatory forces were much less remarkable. The latter suggests that intersegmental motions produced by spinal manipulation may play a prominent role in eliciting therapeutic responses. CONCLUSIONS: The simple analytical model presented in this study can be used to predict the static, cyclic, and impulsive force PA displacement response of the lumbar spine. The model provides data on lumbar segmental and intersegmental motion patterns that are otherwise difficult to obtain experimentally. Modeling of the PA motion response of the lumbar spine to PA forces assists in the understanding the biomechanics of therapeutic PA forces applied to the lumbar spine and may ultimately be used to validate chiropractic technique procedures and minimize risk to patients receiving spinal manipulative therapy.     

Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: a pilot randomized clinical trial

BACKGROUND: To date, no substantiated studies have been performed to investigate the efficacy of spinal manipulative therapy on thoracic spinal syndromes. OBJECTIVE: To investigate the effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain. STUDY DESIGN: A single-blind, randomized, comparative, controlled pilot study. SETTING: Technikon Natal Chiropractic Clinic in Durban, South Africa. PARTICIPANTS: Thirty subjects selected from the general population (from 16 to 60 years old) were randomly divided into two different treatment groups of 15 each. METHODS: The objective measurements collected were the thoracic spine ranges of motion with the BROM II goniometer and pain threshold with an algometer. The subjective information required completion of the Oswestry Back Pain Disability Index, short-form McGill Pain Questionnaire, and Numerical Pain Rating Scale-101 Questionnaire by the patient. These 3 forms and objective measurements were collected before the first and final treatment and again at the 1-month follow-up consultation. The data gathered were then statistically analyzed with use of a 95% confidence level. The nonparametric Mann-Whitney U test and the Wilcoxon signed-rank test were used to compare intergroup and intragroup data, respectively. This was conducted at the alpha =.05 level of confidence. Further assessment of the data was conducted by use of power analysis. INTERVENTIONS: The treatment group received thoracic spinal manipulation. The placebo group received nonfunctional ultrasound application only. The research project was carried out so that both groups received 6 treatments over a period of 2 to 3 weeks. A 1-month follow-up appointment was scheduled after the final treatment to assess the relative long-term benefits of the two different treatments. RESULTS: Statistically significant results (P < or = .025) were noted for the percentage of pain experienced (Numerical Pain Rating Scale) and for right and left lateral flexion during intergroup comparison after the final treatment. The final treatment results were maintained at the 1-month follow-up consultation; however, there were no further statistically significant results. It was noted that the power was weak, so the probability of committing type II error (falsely accepting the null hypothesis) for the other measurements was high. The intragroup analysis showed statistically significant improvements in the group that received spinal manipulative therapy in both subjective and objective measurements between the first to final treatment and the first treatment to the 1-month follow-up consultation. The placebo group analysis showed a statistically significant improvement in sensory pain only (subjective measurement) between the first treatment and the final treatment. CONCLUSIONS: This pilot study suggests that spinal manipulative therapy has greater benefits than placebo treatment. The sample size was small, therefore the findings of this trial study should not be considered conclusive but rather should be used as a foundation for planning future studies. In further studies a larger sample size will be necessary to identify subtle changes in measurement parameters and to add to the validity of the results.     

Cervical radiculopathy: the diagnosis and treatment of pathomechanics in the cervical spine

Lateral flexion anteroposterior roentgenograms of the cervical spine were obtained of patients suffering from cervical radiculopathy. Specific attention was given to the normal mechanical attitudes of the cervical motion segments at their end range. Deviations from the normal coupling mechanism in the cervical spine were directly related to the level of clinical radiculopathy. Aberrancies in the coupling mechanism of the cervical motion segments were reduced by manipulation, and post manipulative reduction examination revealed improvements in sensation, motor power, and deep tendon reflexes, as well as subjective patient improvement. Normal mechanical attitudes could be restored by manipulative reduction of the cervical motion segments.     

Normal global motion of the cervical spine: an electrogoniometric study.

OBJECTIVE: Establishment of a normal database and clinical reference of active global cervical spine motion ranges and patterns using a commercial electrogoniometer. DESIGN: Three-dimensional cervical motion ranges and patterns were analyzed in 250 asymptomatic volunteers. BACKGROUND: In vivo out-of-plane motion patterns of the cervical spine have not yet been reported in large populations, but could be of clinical interest. METHODS: In 250 subjects (aged 14-70 yr), motion range and patterns between the first thoracic vertebra and the head were analyzed for flexion-extension, lateral bending, rotation in neutral sagittal plane position and in full flexion using the CA 6000 Spine Motion Analyzer. RESULTS AND CONCLUSIONS: Average motion range in the sagittal plane was 122 degrees (SD: 18 degrees ). Flexion was slightly more important than extension. Out-of-plane components were negligible. Global bending range averaged 88 degrees (SD: 16 degrees ), left and right bending being comparable. Homolateral rotation was associated to lateral bending. Its extent was approximately 40% of the bending range. Global rotation range in neutral sagittal plane position was 144 degrees (SD: 20 degrees ), without significant difference between right and left rotations. Associated motion components were small. During rotation in flexed head position, global range (134 degrees, SD: 24 degrees ) was comparable to the one in neutral flexion. But heterolateral bending, averaging 60% of the primary motion, was associated to flexed rotation. Significant reduction of all primary (but not conjunct) motions with age were obtained. Sex had no influence on cervical motion range. RELEVANCE: Our results agreed with previous observations, validating the methodology used. They thus constitute reference data of cervical out-of-plane motion for clinical applications.     

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

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

Unilateral and Multiple Cavitation Sounds During Lumbosacral Spinal Manipulation

ObjectiveThe purpose of this study was to determine from which side of the spine the popping sound (PS) emanates during side-lying, rotatory high-velocity low-amplitude (HVLA) thrust manipulation directed to the L5-S1 articulation using a time-frequency analysis. Secondary aims were to calculate the average number of PSs, the duration of lumbar thrust manipulation, and the duration of a single PS.MethodsThirty-four asymptomatic participants received 2 lumbar HVLA thrust manipulations targeting the right and left L5-S1 articulations. Two high sampling rate accelerometers were secured bilaterally 25 mm lateral to the midline of the L5-S1 interspace. For each manipulation, 2 audio signals were extracted and singularly processed via spectrogram calculation to obtain the release of energy over time on each side of the lumbosacral junction.ResultsDuring 60 HVLA thrust manipulations, it was measured a total of 320 PSs. Of those PSs, 176 occurred ipsilateral and 144 occurred contralateral to the targeted L5-S1 articulation; that is, the PS was no more likely to occur on the upside than the downside facet after right or left rotatory L5-S1 HVLA thrust manipulation. Moreover, PSs occurring on both sides at the same time were detected very rarely (ie, 2% of cases) with the lumbar HVLA thrust manipulations. The mean number of audible PSs per lumbosacral HVLA thrust manipulation was 5.27 (range 2-9). The mean duration of a single manipulation was 139.13 milliseconds (95% confidence interval: 5.61-493.79), and the mean duration of a single PS was 2.69 milliseconds (95% confidence interval: 0.95-4.59).ConclusionBased on our findings, spinal manipulative therapy practitioners should expect multiple PSs that most often occur on the upside or the downside facet articulations when performing HVLA thrust manipulation to the lumbosacral junction (ie, L5-S1). However, whether the multiple PSs found in this study emanated from the same joint or adjacent ipsilateral or contralateral facet joints remains unknown. A single model may not necessarily be able to explain all of the audible sounds during HVLA thrust manipulation.     

Patient positioning and spinal locking for lumbar spine rotation manipulation

High velocity low amplitude (HVLA) thrust techniques are widely used by many manual therapists to treat low back pain. There is increasing evidence that spinal manipulation produces positive patient outcomes for acute low back pain. HVLA thrust techniques are associated with an audible release in the form of a pop or cracking sound that is widely accepted to represent cavitation of a spinal zygapophyseal joint. This audible release distinguishes these techniques from other manual therapy interventions. When using long lever HVLA thrust techniques spinal locking is necessary to localize forces and achieve cavitation at a specific vertebral segment. A critical factor in applying lumbar spine manipulation with minimal force is patient positioning and spinal locking. A knowledge of coupled movements of the lumbar spine aids an understanding of the patient positioning required to achieve spinal locking consistent with maximal patient comfort and cooperation. Excessive rotation can result in pain, patient resistance and failed technique. This masterclass presents a model of patient positioning for the lumbar spine that minimizes excessive use of rotation to achieve spinal locking prior to the application of the thrust.     

The effect of manipulation on pain and range of motion in the cervical spine: a pilot study.

OBJECTIVE: The objective of this pilot study was to determine the number of patients required for a randomized controlled trial of spinal manipulation for neck pain and to determine if there is a relationship between pain and range of motion (ROM) in the cervical spine. DESIGN: Fifty consecutive outpatients were studied in a pretest-posttest design without long-term follow-up. SETTING: The patients were taken from a primary cae outpatient teaching clinic specializing in back pain. PATIENTS: All patients had unilateral neck pain without neurological deficit. The patients were selected as a consecutive sample. INTERVENTION: All the patients received a single cervical manipulation. MAIN OUTCOME MEASURES: Prior to and immediately after the treatment, cervical ROM was recorded on a goniometer, and pain intensity was rated on the 101-point numerical rating scale. RESULTS: The results show an increase in all planes of post-treatment ROM and a decrease in post-treatment pain scores. Partial correlations between post-treatment ROM and 101-point numerical rating scale scores reveal a significant relationship between a decrease in pain and an increase in cervical rotation (p < .005). CONCLUSIONS: Since the results of this pilot study are not controlled, they cannot be seen as proof supporting the clinical efficacy of manipulation for neck pain. However, the correlation between an increase in cervical rotation and a decrease in pain is clinically instructive. In addition, the outcome measures used in this study could prove to be useful in the design of future randomized controlled trials of cervical manipulation.     

颈脊柱推拿对减轻慢性颈痛患者肘屈肌抑制机制研究

目的:通过对16例慢性颈痛患者进行研究,测量颈痛患者行颈脊柱推拿前后功能量和主观疼痛改变情况。方法:颈脊柱推拿选定C5-7水平,用插入颤搐方法和肌电描记法评定肘屈肌在最大范围内随意收缩时二头肌激活作用。颈活动度和压痛阈用关节角度计和痛觉计进行测量。结果:治疗前,患者表现典型的二头肌抑制,颈部活动侧面受限,压痛敏感性增高。颈脊柱推拿后,二头肌抑制明显下降并伴随二头肌肌力增强,颈部活动度和压痛阈显著提高。结论:脊柱推拿术可以提高肌肉功能、颈部活动度和疼痛敏感性。     

Immediate Effects of a Single Session of Cervical Spine Manipulation on Cervical Movement Patterns in People With Nonspecific Neck Pain: A Randomized Controlled Trial

ObjectiveThe aim of the present study was to assess the immediate effects of a single session of cervical spine manipulation on cervical movement patterns, disability, and the patient's perceived improvement in people with nonspecific neck pain.MethodsA single-blinded, randomized, sham-controlled trial was carried out at a biomechanics institute. Fifty participants diagnosed with acute and chronic nonspecific neck pain (minimum duration of the symptoms being 1 month) were randomized to an experimental group (EG, n = 25) or a sham-control group (CG, n = 25, 23 of whom completed the study). EG received a single cervical spine manipulation session; CG received a single placebo intervention. Both groups received manipulation or sham from the same physiotherapist. Main outcome measures were neck kinematics (ie, range of motion and movement harmony) during cyclic movements, self-reported neck disability, and impression of change assessed before and 5 minutes after treatment.ResultsThe EG showed no significant improvements (P > .05) in any of the studied biomechanical variables, except for right-side bending and left rotation, in which we found a range of motion significant mean difference of 1.97° and 1.95°, respectively (P < .05). The CG showed enhanced harmonic motion during flexion (P < .05). Both groups showed a significant decrease in self-reported neck disability after treatment (P < .05), and EG participants perceived a significantly larger improvement after manipulation compared with the CG (P < .05).ConclusionsA single session of cervical manipulation provided by a physiotherapist had no impact on cervical motion during cyclic movements, but rather induced self-reported perceived improvement in neck disability and impression of change after treatment in people with nonspecific neck pain.     

Assessment of cervical stiffness in axial rotation among chronic neck pain patients: A trial in the framework of a non-manipulative osteopathic management

BackgroundCervical stiffness is a clinical feature commonly appraised during the functional examination of cervical spine. Measurements of cervical stiffness in axial rotation have not been reported for patients with neck pain. The purpose of this study was to investigate cervical spine stiffness in axial rotation among neck pain patients and asymptomatic subjects, and to analyze the impact of osteopathic management.MethodsThirty-five individuals (17 patients) were enrolled. Measurements were carried out for left-right axial rotation using a torque meter device, prior and after intervention. Passive range of motion, stiffness, and elastic-and neutral zone magnitudes were analyzed. Pain intensity was also collected for patients. The intervention consisted in one single session of non-manipulative osteopathic treatment performed in both groups.FindingsA significant main effect of intervention was found for total range of motion and neutral zone. Also, treatment by group interaction was demonstrated for neutral-, elastic zone, stiffness in right axial rotation, and for total neutral zone. Significant changes were observed in the clinical group after intervention, indicating elastic zone decrease and neutral zone increase. In contrast, no significant alteration was detected for the control group.InterpretationsStiffness characteristics of the cervical spine in axial rotation are prone to be altered in patients with neck pain, but seem to be relieved after a session of non-manipulative manual therapeutic techniques. Further investigations, including randomized clinical trials with various clinical populations and therapeutic modalities, are needed to confirm these preliminary findings.     

Decrease in elbow flexor inhibition after cervical spine manipulation in patients with chronic neck pain

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.     

Effects of Cervical Joint Manipulation on Joint Position Sense of Normal Adults

[Purpose] The purpose of this study was to identify the effects of cervical joint manipulation on joint position sense (JPS) of normal adults. [Subjects] Thirty normal adults were divided into a test group of 15 subjects and a control group of 15 subjects. [Methods] The test group was treated with cervical joint manipulation and massage, whereas the control group received only massage. Both groups were evaluated in terms of joint position error (JPE) using a digital dual clinometer before and after the interventions. [Results] The comparision of the pre- and post-test results revealed the test group exhibited statistically significant changes in flexion, extension, left lateral flexion, right lateral flexion, left rotation, and right rotation. On the other hand, the control group showed no statistically significant changes in any of the variables. [Conclusion]Cervical joint manipulation reduced JPE and improved joint position sence. Therefore, we consider its application to the treatment of patients with cervical problems in clinical practice is desirable.Key words: Cervical joint manipulation, Joint position sense, Joint position error     

颈椎荣通方联合旋提手法治疗神经根型（气滞血瘀型）颈椎病的临床疗效观察

摘要：目的：观察和评价中药颈椎荣通方联合旋提手法在治疗气滞血瘀型神经根型颈椎病的临床治疗效果。方法：选取2018年10月至2020年01月江西中医药大学附属医院门诊收治符合神经根型颈椎病诊断,中医辩证分型为气滞血瘀证的80例患者,采用单盲、随机数字表法、按就诊顺序分为观察组40例、对照组40例。观察组采用自拟颈椎荣通方结合旋提手法治疗,对照组仅采用旋提手法治疗,疗程均为两周。比较两组治疗两周后的临床疗效、视觉疼痛模拟评分（VAS）、颈椎弓弦距。结果：经两周治疗后,观察组总有效率（92.50%）明显高于对照组（75.00）%,P<0.05,差异均具有统计学意义;治疗后视觉疼痛模拟评分（VAS）观察组（1.22±1.54)明显低于对照组（2.52±1.76）,P<0.05,差异均具有统计学意义;观察组治疗前后颈椎弓弦距差值（1.03±0.24）高于对照组（0.52±0.14）,P<0.05,差异均具有统计学意义。结论：颈椎荣通方结合旋提手法治疗神经根型（气滞血瘀证型）颈椎病较单纯应用旋提手法治疗疗效更优,值得临床推广应用。