Primary headaches and painful spontaneous cervical artery dissection

The relation between primary headaches (PH) and pain related to spontaneous cervical artery dissection (SCAD) is still unclear, as well as the progress of PH after dissection. To investigate this relation, the characteristics of pain related to SCAD and changes in PH patterns after SCAD, we evaluated 54 consecutive patients. Thirty-five (65%) had previous PH. Painful SCAD occurred in 39 (72%). Frontal and parietal localizations were significantly associated with internal carotid artery dissection (p=0.013 and p=0.010, respectively), whereas occipital and nuchal pain, with vertebral artery dissection (p=0.047 and p<0.001, respectively). Previous PH did not influence the presence of pain at SCAD onset. Twenty-six (74%) patients with PH reported improvement in PH pattern after a mean follow-up of 32 months. These results suggest that mechanisms underlying PH do not modulate dissection-related pain. Disruption of perivascular afferents may be involved in improvement of PH patterns after SCAD.     

Effects of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study

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.     

Spinal manipulation: Indications,risks and benefits

High velocity low amplitude (HVLA) thrust techniques are widely used by many manual medicine disciplines to treat spinal dysfunction. Techniques of this type 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 HVLA thrust techniques from other manual medicine interventions. Common indications for the use of HVLA thrust techniques are ‘joint fixation’, ‘joint locking’ and somatic dysfunction but various authors have also described other indications for the therapeutic use of these techniques. Despite a wide range of indications, there has been a decline in the use of HVLA thrust techniques. Concern regarding patient safety and the difficulty associated with gaining mastery of HVLA thrust techniques may be reasons for the decline in their use. While there are potential serious sequelae from the use of HVLA thrust techniques, the risks are low provided patients are thoroughly assessed and treated by appropriately trained practitioners. With increasing evidence that spinal manipulation produces positive patient outcomes for acute low back pain and some categories of neck pain and headache, there is a need to look critically at the indications for the use of HVLA thrust techniques as well as the actual risks and potential benefits of this therapeutic modality.     

Informed choice and consent for cervical spine manipulation

Informed consent is essential in ethical health care practice. Information and advice regarding choices is a precondition of informed consent. Autonomy, truthfulness and ethical decision making are all relevant to the informed choice and consent process. The purpose of this paper is firstly to discuss these topics. Following this, a case of informed choice and consent for cervical spine manipulation is examined. This case illustrates ethical problems that can arise in the informed choice and consent process. The moral reasoning in the case is clarified with the assistance of an ethical grid. The conclusion is that autonomy, a patient's right to self determination, is paramount in the informed choice and consent process. Autonomy enhancing informed consent requires more than a mechanical recitation of procedures, hazards and options. In order to uphold a patient's right to self determination, patients need to be included in the decision making process by allowing them to make treatment choices based on accurate information and advice from the physiotherapist.     

颈椎旋转手法的扳动方向与颈椎旋转角度的关系

目的:探讨颈椎旋转手法的扳动方向对颈椎旋转角度的影响。方法:选取28名健康受试者,随机分为4组,每组7人。分别对4组受试者行一侧或两侧颈椎定点旋转手法。测量4组受试者每次手法扳动前、后颈椎旋转的主动活动和被动活动范围。结果:向一侧扳动后,颈椎向两侧的主动旋转度显著增大(P0.05),且扳动侧的改变幅度大于对侧;向两侧分别扳动颈椎,第一次扳动侧的主动活动度增大(P0.05),但明显小于仅向一侧扳动时(P0.01);无论是向一侧或是两侧扳动颈椎,都不会明显改变颈椎的被动旋转范围(P0.05)。结论:为了改善患者的颈椎主动旋转范围,颈椎旋转手法的扳动方向应与患者颈椎主动旋转受限的方向一致且仅扳动一次。     

Spinal manipulation force and duration affect vertebral movement and neuromuscular responses

BACKGROUND: Previous study in human subjects has documented biomechanical and neurophysiological responses to impulsive spinal manipulative thrusts, but very little is known about the neuromechanical effects of varying thrust force-time profiles. METHODS: Ten adolescent Merino sheep were anesthetized and posteroanterior mechanical thrusts were applied to the L3 spinous process using a computer-controlled, mechanical testing apparatus. Three variable pulse durations (10, 100, 200 ms, force = 80 N) and three variable force amplitudes (20, 40, 60 N, pulse duration = 100 ms) were examined for their effect on lumbar motion response (L3 displacement, L1, L2 acceleration) and normalized multifidus electromyographic response (L3, L4) using a repeated measures analysis of variance. FINDINGS: Increasing L3 posteroanterior force amplitude resulted in a fourfold linear increase in L3 posteroanterior vertebral displacement (p < 0.001) and adjacent segment (L1, L2) posteroanterior acceleration response (p < 0.001). L3 displacement was linearly correlated (p < 0.001) to the acceleration response over the 20-80 N force range (100 ms). At constant force, 10 ms thrusts resulted in nearly fivefold lower L3 displacements and significantly increased segmental (L2) acceleration responses compared to the 100 ms (19%, p = 0.005) and 200 ms (16%, p = 0.023) thrusts. Normalized electromyographic responses increased linearly with increasing force amplitude at higher amplitudes and were appreciably affected by mechanical excitation pulse duration. INTERPRETATION: Changes in the biomechanical and neuromuscular response of the ovine lumbar spine were observed in response to changes in the force-time characteristics of the spinal manipulative thrusts and may be an underlying mechanism in related clinical outcomes.     

Spinal manipulations for cervicogenic headaches: a systematic review of randomized clinical trials

The objective of this systematic review was to assess the effectiveness of spinal manipulations as a treatment option for cervicogenic headaches. Seven databases were searched from their inception to February 2011. All randomized trials which investigated spinal manipulations performed by any type of healthcare professional for treating cervicogenic headaches in human subjects were considered. The selection of studies, data extraction, and validation were performed independently by 2 reviewers. Nine randomized clinical trials (RCTs) met the inclusion criteria. Their methodological quality was mostly poor. Six RCTs suggested that spinal manipulation is more effective than physical therapy, gentle massage, drug therapy, or no intervention. Three RCTs showed no differences in pain, duration, and frequency of headaches compared to placebo, manipulation, physical therapy, massage, or wait list controls. Adequate control for placebo effect was achieved in 1 RCT only, and this trial showed no benefit of spinal manipulations beyond a placebo effect. The majority of RCTs failed to provide details of adverse effects. There are few rigorous RCTs testing the effectiveness of spinal manipulations for treating cervicogenic headaches. The results are mixed and the only trial accounting for placebo effects fails to be positive. Therefore, the therapeutic value of this approach remains uncertain.     

Spinal manipulation causes variable spine kinematic and trunk muscle electromyographic responses

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.     

旋转手法治疗椎动脉型颈椎病的安全性

目的探讨旋转手法治疗椎动脉型颈椎病的临床疗效及安全性。方法对 180例椎动脉型颈椎病患者采用颈椎定位旋转手法进行治疗。结果结果 :经随访 ,治愈 89例 ,显效 73例 ,有效 18例 ,总愈显率为 81% ,无 1例发生治疗意外。结论旋转手法是治疗椎动脉型颈椎病的有效方法 ,正确的诊断及适应证选择是取得良好临床效果和保证治疗安全性的关键。     

Spinal manipulation or mobilization for radiculopathy: a systematic review

In this systematic review, we present a comprehensive and up-to-date systematic review of the literature as it relates to the efficacy and effectiveness of spinal manipulation or mobilization in the management of cervical, thoracic, and lumbar-related extremity pain. There is moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy. The quality of evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low. At present, no evidence exists for the treatment of thoracic radiculopathy. Future high-quality studies should address these conditions.