The following abstracts come from two sources: the Journal of Manipulative and Physiological Therapeutics (published nine times annually) and the Journal of Chiropractic Medicine (published quarterly).
Lumbosacral Radiculopathy: Don’t Overlook the Impact of Forward Head Posture
Objective: The purpose of this study was to determine the immediate and long-term effects of a multimodal program, with the addition of forward head posture correction, in patients with chronic discogenic lumbosacral radiculopathy.
Methods: This randomized clinical study included 154 adult patients (54 females) who experienced chronic discogenic lumbosacral radiculopathy and had forward head posture. One group received a functional restoration program, and the experimental group received forward head posture corrective exercises. Primary outcomes were the Oswestry Disability Index (ODI). Secondary outcomes included the anterior head translation, lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, pelvic inclination, leg and back pain scores, and H-reflex latency and amplitude. Patients were assessed at three intervals (pretreatment, 10-week posttreatment, and two-year follow-up).
Results: A general linear model with repeated measures indicated a significant group × time effect in favor of the experimental group on the measures of ODI (F = 89.7; P < .0005), anterior head translation (F = 23.6; P < .0005), H-reflex amplitude (F = 151.4; P < .0005), H-reflex latency (F = 99.2; P < .0005), back pain (F = 140.8; P < .0005), and leg pain (F = 72; P < .0005). After 10 weeks, the results revealed an insignificant difference between the groups for ODI (P = .08), back pain (P = .29), leg pain (P = .019), H-reflex amplitude (P = .09), and H-reflex latency (P = .098). At the two-year follow-up, there were significant differences between the groups for all variables adopted for this study (P < .05).
Conclusions: The addition of forward head posture correction to a functional restoration program seemed to positively affect disability, three-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.
Source: Moustafa IM, et al. The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study. JMPT, Mar-Apr 2015;38(3):167-78.
ANS Responses to Upper and Lower Cervical SMT
Objective: The aims of this study were to examine autonomic nervous system responses by using heart rate variability analysis (HRV), hemodynamic parameters and numeric pain scale (NPS) when either upper (C1 and C2) or lower (C6 and C7) cervical segments were manipulated in volunteers, and whether such response would be altered in acute mechanical neck pain patients after spinal manipulative therapy (SMT).
Methods: A randomized controlled, cross-over, preliminary study was conducted on 10 asymptomatic normotensive volunteers and 10 normotensive patients complaining of acute neck pain. HRV, blood pressure (BP) and heart rate (HR), and NPS were recorded after upper cervical and lower cervical segments SMT in volunteer and patient groups.
Results: The standard deviation of average normal to normal R-R intervals (SDNN) increased (83.54 ± 22 vs. 105.41 ± 20; P = .02) after upper cervical SMT. The normalized unit of high frequency (nuHF), which shows parasympathetic activity, was predominant (40.18 ± 9 vs. 46.08 ± 14) after upper cervical SMT (P = .03) with a significant decrease (109 ± 10 vs. 98 ± 5) in systolic BP (P = .002). Low frequency to high frequency (LF/HF) ratio, which shows predominance of sympathetic activity increased (1.05 ± 0.7 vs. 1.51 ± 0.5; P = .02) after lower cervical SMT in the healthy volunteers group. However, there was an increase in SDNN (70.48 ± 18 vs. 90.23 ± 20; P = .02 and 75.19 ± 16 vs 97.52 ± 22; P = .01), a decrease in LF/HF ratio (1.33 ± 0.3 vs. 0.81 ± 0.2; P = .001 and 1.22 ± 0.4 vs. 0.86 ± 0.3; P = .02), which was associated with decreased systolic BP (105 ± 10 vs. 95 ± 9; P = .01 and 102 ± 9 vs. 91 ± 10; P = .02) and NPS scores (3 ± 1 vs. 0; P = .01 and 3 ± 1 vs. 1 ± 1; P = .03) following both upper and lower cervical SMT in the patient group. The baseline HR was 67 ± 9 vs 64 ± 5 (upper cervical) and 65 ± 7 vs 69 ± 11 (lower cervical) in both the healthy volunteer and patient groups.
Conclusion: Upper cervical SMT enhances dominance of parasympathetic and lower cervical SMT enhances dominance of sympathetic activity in this young volunteer group. However, dominance of parasympathetic activity was found in patients with neck pain that received both upper and lower cervical SMT.
Source: Win NN, et al. Effects of upper and lower cervical spinal manipulative therapy on blood pressure and heart rate variability in volunteers and patients with neck pain: a randomized controlled, crossover, preliminary study. J Chiro Med, Mar 2015;14(1):1-9.
Chiropractic Care for Low Back Pain With Hip Dysplasia
Objective: The purpose of this case report is to describe chiropractic management of an elderly man with untreated bilateral hip joint dysplasia presenting with mild acute mechanical low back pain.
Clinical Features: A 75-year-old man presented with an insidious-onset intermittent low back pain of three days’ duration. Physical examination findings supported a mechanical cause for mild acute low back pain. Plain radiography revealed dysplasia of hip joints with absence of femoral heads and necks and bilateral high dislocation.
Intervention and Outcome: Chiropractic management included vibration, mobilization, light drop-piece adjustments of the lower lumbar and sacroiliac joints, and recommendation of the use of heat at home. Treatments were given three times over the course of one?week. The low back pain intensity over this period dropped from 5 to 0 on an 11-point numerical rating scale, and the patient was discharged.
Conclusion: This patient with substantial postural and gait abnormalities as a result of severe bilateral hip dysplasia associated with an unusual pattern of osteoarthritic change in the spine responded favorably to a short course of chiropractic care.
Source: Murray KJ, et al. Chiropractic management of low back pain in a 75-year-old man with bilateral developmental hip dysplasia. J Chiro Med, Mar 2015;14(1):46-50.
Trigger-Point Dry Needling: An Effective Addition to Your Shoulder Pain Protocol?
Objective: The purpose of this study was to evaluate the effects of including one session of trigger-point dry needling (TrP-DN) into a multimodal physiotherapy treatment on pain and function in postoperative shoulder pain.
Methods: Twenty patients (five male, 15 female; ages 58 ± 12 years) with postoperative shoulder pain after either open reduction and internal fixation with a Proximal Humeral Internal Locking System plate or rotator-cuff tear repair were randomly divided into two groups: physiotherapy group (n = 10) who received best-evidence physical therapy interventions; and a physical therapy plus TrP-DN group (n = 10), who received the same intervention plus a single session of TrP-DN targeted at active TrPs. The Constant-Murley score was used to determine pain, activities of daily living, range of motion, and strength, which was captured at baseline and one week after by an assessor blinded to group assignment.
Results: Analysis of variance showed that subjects receiving TrP-DN plus physical therapy exhibited greater improvement in the Constant-Murley total score (P < .001) and also activities of daily living (P < .001) and strength (P = .019) subscales than those receiving physical therapy alone. Between-group effect sizes were large in favor of the TrP-DN group (0.97 < SMD < 1.45). Both groups experienced similar improvements in pain (P < .001) and range of motion (P < .001).
Conclusions: Our results suggest that including a single session of TrP-DN in the first week of a multimodal physical therapy approach may assist with faster increases in function in individuals with postoperative shoulder pain.
Source: Arias-BurÃa JL, et al. Inclusion of trigger-point dry needling in a multimodal physical therapy program for postoperative shoulder pain: a randomized clinical trial. JMPT, Mar-Apr 2015;38(3):179-87.