Objective: The purpose of this study was to examine the immediate effects of spinal manipulative therapy (SMT) on trunk proprioception in subjects with asymptomatic chronic low back pain (CLBP) and determine if those effects lasted one week.

Methods: This unbalanced randomized, controlled crossover design examined 33 subjects with CLBP. Proprioception was tested via joint position sense, threshold to detect passive motion (TTDPM), direction of motion (DM), and force reproduction. Each subject received lumbar manipulation or a sham procedure followed by proprioception retest. This procedure was repeated one week later using the opposing treatment. Subjects receiving SMT in the second session returned a third time, receiving the sham procedure again.

Results: Spinal manipulative therapy produced an effect for TTDPM in the manipulation first group (P = .008); the sham procedure produced an effect for joint position sense in the sham first group (P = .005). Spinal manipulative therapy had a one-week effect for the manipulation first group (P = .006). No effect was noted for either DM or force reproduction.

Conclusions: Results suggest SMT had minimal immediate effect on trunk proprioception. The effects noted occurred in session 1, implicating learning as a potential source. Learning, from repetitive proprioception training may enhance neuromuscular control in subjects with CLBP before the use of therapeutic exercise. Subjects showed smaller deficits than previously reported for TTDPM or DM, suggesting proprioception deficits may correlate with pain level.

Handedness Influences Passive Shoulder Range of Motion in Nonathlete Adult Women
Ana Lucia F. Conte, PT, Amelia P. Marques, PhD, Raquel A. Casarotto, PhD, and Silvia M. Amado-joao, PhD

Objective: The purpose of this study was to determine whether handedness influences bilateral shoulder range of motion in nonathlete adult women.

Methods: This was an observational study. Shoulder range of motion (flexion, abduction, horizontal adduction, extension, external and internal rotation) was passively and bilaterally measured in 50 female, right-handed, healthy university students, ranging from 20 to 29 years of age, who were not practicing repetitive activities with the upper limbs at the time of this study. The assessment was performed with a universal goniometer, twice for each subject by the same examiner. The first and second measurements were correlated using the intraclass correlation coefficient, which was high for all movements and ranged from 0.80 to 0.97. The student t test and Wilcoxon test were used to compare the range of motion between the dominant and nondominant shoulders and the mean differences between the two sides. The effect of size was ∞ = .05.

Results: There is statistically significance difference between the two sides when the rotational range of motion is compared; the dominant shoulder presented increased external rotation (mean, 4.74°; 95% confidence interval, 1.61-7.87) and decreased internal rotation (mean, 3.52°; 95% confidence interval, 1.64-5.4) compared to the opposite shoulder.

Conclusion: Dominance should be considered when shoulder rotation is evaluated, even in nonathlete adult women.

Comparison of Manual Lymph Drainage Therapy and Connective Tissue Massage in Women With Fibromyalgia
Gamze Ekici, PT, PhD, Yesim Bakar, PT, PhD, Turkan Akbayrak, PT, PhD, and Inci Yuksel, PT, PhD

Objective: This study analyzed and compared the effects of manual lymph drainage therapy (MLDT) and connective tissue massage (CTM) in women with primary fibromyalgia (PFM).

Methods: The study design was a randomized, controlled trial. Fifty women with PFM completed the study. The patients were divided randomly into two groups. Whereas 25 of them received MLDT, the other 25 underwent CTM. The treatment program was carried out five times a week for three weeks in each group. Pain was evaluated by a visual analogue scale and algometry. The Fibromyalgia Impact Questionnaire (FIQ) and Nottingham Health Profile were used to describe health status and health-related quality of life (HRQoL). Wilcoxon signed rank test and Mann-Whitney U test were used to analyze the data.

Results: In both groups, significant improvements were found regarding pain intensity, pain pressure threshold, and HRQoL (P <.05). However, the scores of FIQ-7 (P =.006), FIQ-9 (P =.006), and FIQ-total (P=.010) were significantly lower in the MLDT group than they were in the CTM group at the end of treatment.

Conclusion: For this particular group of patients, both MLDT and CTM appear to yield improvements in terms of pain, health status, and HRQoL. The results indicate that these manual therapy techniques might be used in the treatment of PFM. However, MLDT was found to be more effective than CTM according to some subitems of FIQ (morning tiredness and anxiety) and FIQ total score. Manual lymph drainage therapy might be preferred; however, further long-term follow-up studies are needed.

Spinal Postural Alignment Variance According to Sex and Age in 7- and 8-Year-Old Children
Patricia Jundi Penha, Marina Baldini, and Silvia Maria Amado-Joao, PhD

Purpose: Children's postural alignment undergoes many adjustments due to the changes in body proportions during the stages of growth. The objective of this study was to quantitatively characterize and analyze spinal postural standards in 7- and 8-year-old children to verify which of the differences found correlated to age and sex.

Methods: Two hundred thirty public school students (Amparo, Sao Paulo, Brazil), ages 7 to 8 years, were divided into groups according to postural alignment, which were further subdivided by sex and age, for comparison. Digital photos of upright subjects were analyzed to evaluate posture. Lumbar and thoracic curvature, pelvic inclination, head posture, and lateral spine deviation were measured using CorelDraw (Ottawa, Canada) software guidelines and bone landmarks. Descriptive statistics and analysis of variance data analysis were utilized to verify differences among the groups. This was a cross-sectional, descriptive study.

Results: Mean values for the variables analyzed were calculated. For lumbar lordosis, 7-year-old boys showed 38.49° ± 15.32° in comparison to all other groups (42.29° ± 7.13°). For thoracic kyphosis, the 7-year-old children presented 28.07° ± 7.73,° and the 8-year-olds 30.32° ± 7.73.° Pelvic inclination presented a mean value of 15.82° ± 5.46° and single lateral spine deviation mean value of 3.48° ± 2.12.°

Conclusion: For the sample studied, differences based on sex and age were found for some of the body segments analyzed. The values found in this study may contribute to improved physiotherapeutic treatment when associated with other aspects of the clinical assessment and symptomatology.

Epidemiology of Musculoskeletal Injuries Among Students Entering a Chiropractic College
Harrison T. Ndetan, MSc, MPH, Ronald L. Rupert, MS, DC, Sejong Bae, PhD, and Karan P. Singh, PhD

Objective: The purpose of this study was to report the prevalence, distribution, and severity of injuries to students before entering chiropractic college and to explore the possible demographic risk factors to these injuries.

Methods: A cross-sectional survey was administered to first-year chiropractic students (n = 255) of one chiropractic college. Survey questions were adopted from the Standardized Nordic and Outcome Assessment Health Status Questionnaires. Data were collected on severity and period of last perception of low back, hand/wrist (HW), and neck/shoulder (NS) injuries of the students before attending chiropractic college.

Results: The response rate was 98.8% (N = 252), among which 66.7% were males. Injury prevalence to low back, HW and NS before attending chiropractic college was 50.4%, 40.1% and 53.2%, respectively. Of the respondents, 48.8% were overweight/obese and were more likely to report injuries to HW (odds ratio, 2.10; 95% confidence interval, 1.25-3.51) and NS (odds ratio, 1.70; 95% confidence interval, 1.04-2.73) compared with those with normal weight. Among those with injuries, the mean body mass index for the females was significantly greater than for the males.

Conclusion: This study identified a high prevalence of musculoskeletal injuries among students before attending this particular chiropractic college. Only a small percentage of those injuries were severe enough to impede normal daily work. From this study sample, it seems that males entering this chiropractic college tend to report more injuries than females. However, females with high BMI seemed to report more previous injuries.

Prevalence of Musculoskeletal Injuries Sustained by Students While Attending a Chiropractic College
Harrison T. Ndetan, MSc, MPH, Ronald L. Rupert, MS, DC, Sejong Bae, PhD, and Karan P. Singh, PhD

Objective: The purpose of this study was to assess the prevalence, distribution, severity and risk factors of, and response to, musculoskeletal injuries to the low back, hand/wrist and neck/shoulder among chiropractic students while receiving and/or administering adjustments/manipulation while attending a chiropractic college.

Methods: The study was an epidemiologic survey of chiropractic students at all levels of training (n = 890) at one chiropractic college. A self-administered, anonymous, three-paged questionnaire was used. The questionnaire was divided into sections for collecting data separately on injuries associated with receiving or administering chiropractic adjustments.

Results: The response rate was 64.3% with 62.6% male respondents. The overall prevalence of injuries sustained in college was 31.5%, 44.4% of which was exacerbations of prior complaints. Injuries from receiving adjustments/ manipulation were most prevalent to neck/shoulder (65.7%), whereas hand/wrist injuries were most common when administering adjustments (45.6%). The risk difference among students receiving adjustments was 81.6/1,000 neck/ shoulder injuries, and the etiologic fraction was 76.6%. The risk difference was 170/1,000 hand/wrist injuries with etiologic fraction of 96.5% among students administering adjustments. Diversified, Gonstead, and upper-cervical adjusting techniques were perceived to be the most injury-related.

Conclusion: Some students enroll in a chiropractic college with preexisting injuries that can easily be exacerbated. Others sustain new injuries of moderate severity from receiving and administering adjustments. Potential risk factors may include height, body mass index, and nonexercising. The risk factors and mechanisms responsible for the high levels of hand/wrist injuries need further examination. This research identifies an important need to design a comprehensive and logical protocol to prevent injury to chiropractic students.

An Epidemiologic Survey of Shoulder Pain in Chiropractic Practice in Australia
Mario Pribicevic, M Chiro, Henry Pollard, Grad Dip Chiro, M Sport Sc, PhD, and Rod Bonello, DC, DO, MHA

Objective: This survey investigated the demographic characteristics of the responding practitioners, the prevalence of shoulder pain symptoms seen in weekly chiropractic practice, the sources of shoulder pain, the chiropractor-diagnosed prevalence of shoulder clinical syndromes, and the management strategies for Australian chiropractors.

Methods: A survey was created by the authors consisting of questions seeking demographic information from the respondents, shoulder syndrome and shoulder management information. The survey was mailed to every chiropractic practitioner based in the Australian state of New South Wales (general population 6.8 million in 2005). Contact details were derived from Yellow Pages online listings.

Results: One thousand thirty-seven surveys were mailed to New South Wales-based chiropractors, with 192 (21%) returning a completed survey. The prevalence of shoulder pain symptoms as reported by the practitioners was 12% of the total weekly patients, with the major cause of symptoms related to overuse (32%). The most prevalent working diagnosis of shoulder pain was shoulder impingement syndrome (13%), followed by impingement syndrome with rotator cuff tendonosis (17%), impingement syndrome without rotator cuff tendonosis (14%) and chiropractic shoulder subluxation (12%). Shoulder pain is managed with a combination of manipulation, mainly diversified technique (81%), peripheral joint manipulation (82%), and various soft-tissue strategies used by 92% of practitioners. Rehabilitation strategies were also used by 89% of practitioners, with a main emphasis placed on rotator-cuff strengthening.

Conclusion: The results suggest a moderate prevalence of shoulder pain in clinical practice, with the most prevalent structure involved being the rotator-cuff tendon. Most practitioners use a multimodal therapeutic treatment approach in managing disorders of the shoulder.