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Risk Factors Associated With Back Pain: A Cross-Sectional Study of College Students
David P. Gilkey, DC, PhD, Thomas J. Keefe, PhD, Jennifer L. Peel, PhD, MPH, et al.
Objective: The purpose of this study was to evaluate standard measures of health behavior for association with back pain among college students using data from the standardized National College Health Assessment survey. This investigation evaluated potential risk factors among a population of students at a Colorado university.
Methods: This cross-sectional study included 963 survey results that were assessed using backward-selection logistic regression techniques to evaluate the associations between common college-life health behaviors and back pain occurrence within the past school year.
Results: Thirty-eight percent of college students surveyed reported having back pain within the past school year. Investigators found that univariate associations included multiple domains, but only psychosocial factors remained statistically significant in a final regression model and were associated with back pain. Feeling chronically fatigued (odds ratio, 3.89; 95% confidence interval, 1.09-13.86) and being in an emotionally abusive relationship (odds ratio, 2.78; 95% confidence interval, 1.69-4.57) were the factors most strongly associated with back pain in the final model.
Conclusions: Psychosocial factors were identified to be associated with back pain. The prevalence of back pain among this younger population is of significant concern and warrants further investigation to identify contributing factors that may help in the development of interventions to reduce the epidemic of back pain within college students and lessen the burden upon college health providers.
Manipulative Therapy in Addition to Usual Care for Patients With Shoulder Complaints
Gert J. Bergman, PhD, Jan C. Winters, MD, PhD, Klaas H. Goenier, PhD, et al.
Objective: The purpose of this study was to examine the effect of manipulative therapy on the shoulder girdle, in addition to usual care provided by the general practitioner, on the outcomes of physical examination tests for the treatment of shoulder complaints.
Methods: This was a randomized controlled trial in a primary care setting in the Netherlands. A total of 150 participants were recruited from December 2000 until December 2002. All patients received usual care by the general practitioner. Usual care included one or more of the following depending on the needs of the patient: information/advice, oral analgesics or nonsteroidal anti-inflammatory drugs, corticosteroid injections, exercise, and massage. In addition to usual care, the intervention group received manipulative therapy, up to six treatment sessions in a 12-week period. Twenty-four physical examination tests were done at baseline and after six, 12 and 26 weeks. Factor analysis was done to reduce the number of outcome measures.
Results: The factor analysis resulted in four factors: "shoulder pain," "neck pain," "shoulder mobility," and "neck mobility." At six weeks, no significant differences between groups were found. At 12 weeks, the mean changes of all four factors favored the intervention group; the factors "shoulder pain" and "neck pain" reached statistical significance (95% confidence interval [CI], 0.1-2.1). At 26 weeks, differences in the factors "shoulder pain" (95% CI, 0.0-2.6), "shoulder mobility" (95% CI, 0.2-1.7), and "mobility neck" (95% CI, 0.2-1.3) statistically favored the intervention group.
Conclusion: In this pragmatic study, manipulative therapy, in addition to usual care by the general practitioner, diminished severity of shoulder pain and neck pain and improved shoulder and neck mobility.
Effects of HVLA Manipulation on Strength and Basal Tonus of Female Pelvic Floor Muscles
Berta Simon Nogueira de Almeida, PhD, DO, et al.
Objective: Spinal manipulation with high-velocity and low-amplitude (HVLA) manipulation is frequently used for the treatment of lumbopelvic pain; however, the effect on the pelvic floor has been poorly studied in the past. The objective of this study was to quantify the intravaginal pressure (IVP) and the basal perineal tonus (BPT), measured in terms of pressure, before and after the HVLA manipulation, in patients without neuromuscular and skeletal dysfunctions.
Methods: In this experimental, noncontrolled, nonrandomized study, IVP was obtained through a perineometer introduced into each volunteer's vagina while in dorsal horizontal decubitus. Forty young, healthy university volunteer women with no history of vaginal delivery participated. All voluntary contractions of the perineal muscles were measured in three different ways: phasic perineal contraction (PPC), tonic perineal contraction, and perineal contraction associated to accessory muscles. New pressure measurements were obtained immediately after the HVLA manipulation on each volunteer's sacrum. The pressures were registered and transcribed directly to a personal computer with specific software.
Results: The average IVPs obtained in millimeters of mercury before and after the HVLA manipulation were 56.01 (±25.54) and 64.65 (±25.63) for PPC, 445.90 (±186.84) and 483.14 (±175.29) for tonic perineal contraction, and 65.62 (±26.56) and 69.37 (±25.26) for perineal contraction associated to accessory muscles, respectively. There was significant statistical variation only for PPC (P = .0020) values. The BPT increased regardless of the type of contraction (P < .05).
Conclusion: High-velocity and low-amplitude manipulation of the sacrum was associated with an increase of PPC and of BPT in women who had no associated osteoarticular diseases. These preliminary discoveries could be helpful in the future study of the treatment of women with perineal hypotony.
Variable Morphology of the Axis Vertebrae in 100 Specimens: Palpation and Imaging Implications
Fan Ji-Hong, MD, Wu Li-Ping, MD, Li Yi-Kai, PhD, et al.
Objective: The purpose of this study was to investigate and measure the variable morphologies of axis vertebrae and explore the clinical significance of variations as it may pertain to clinical palpation and diagnostic imaging.
Methods: The common variable morphologies in 100 specimens of intact, dry, adult axis vertebrae (Chinese) were investigated and measured. The frequencies in deviation of odontoid processes, deviation of spinous processes, and presence of bifid spinous processes were observed. The distances between the apices of transverse processes and inferior articular facets were also measured.
Results: Variable morphologies of C2 that we observed were deviation of odontoid processes (14 cases, 14.0%), deviation of spinous processes (three cases, 3.0%), and bifid spinous processes (95 cases, 95.0%). Of the bifid spinous processes, 56 had a process on the left side equal to the right side, 21 were longer on the left, and 18 were longer on the right. The distances between apices of transverse processes and inferior articular facets in the left side of C2 were 17.67 ± 2.47 mm, and that of the right side were 17.81 ± 2.55 mm.
Conclusions: Because variable morphology of the axis is common, congenital deviation of the odontoid process, deviation of the spinous process, and asymmetrical bifid spinous processes should be taken into account during clinical palpation and diagnostic imaging.
Immediate and Carryover Changes of C5-6 Joint Mobilization on Shoulder Muscle Strength
Sharon S. Wang, PT, PhD, Jim Meadows, PT
Objective: Clinical evidence has shown that extremity dysfunction, such as muscle weakness or inhibition, is associated with spinal disorders. Spinal manual therapy is a common therapeutic approach used to address extremity muscle weakness. The purpose of the study was to assess changes in the maximal muscle strength of the shoulder external rotators immediately and at 10, 20 and 30 minutes after cervical joint mobilization at the C5-6 segment.
Methods: Eighteen participants with existing or a history of neck pain were screened by two investigators independently for muscle weakness of shoulder external rotators. Fifteen qualified participants underwent shoulder external rotator strength testing with a handheld dynamometer. Each participant was tested six times: twice before, immediately after, and at 10, 20, and 30 minutes after a C5-6 joint mobilization on the involved side. The two strength data collected before the mobilization were used to determine intratester reliability.
Results: The intratester reliability of the shoulder external rotator strength was excellent (intraclass correlation coefficient3,2 = 0.985). One-way analysis of variance with repeated measures showed a statistical significance in strength data (P = .002). Post hoc tests revealed a significant increase between pre-joint mobilization and immediately post-joint mobilization (P = .003) and between pre-joint mobilization and 10-minute post-joint mobilization (P < .001).
Conclusions: The results of the study suggest that C5-6 joint mobilization increases muscle strength of the shoulder external rotators immediately and its effect carries over for 10 minutes but not after 20 minutes.
JMPT abstracts appear in DC with permission from the journal. Due to space restrictions, we cannot always print all abstracts from a given issue. Visit www.journals.elsevierhealth.com/periodicals/ymmt for access to the complete February 2010 issue of JMPT.