Wilco Meijne, Katinka van Neerbos, Geert Aufdemkampe and Peter van der Wurff.
Objectives: The purpose of this study was to determine the intra and interexaminer reliability of the Gillet test.
Study Design: In a test-retest study, the incidence of asymmetric or symmetric sacroiliac joint motion was investigated using the Gillet test.
Methods: Forty-one male subjects volunteered for this study (mean age: 23 +/- 24 years). Thirty-eight subjects were examined in the first test procedure, and at least four days later thirty-seven subjects were examined again. The subjects were subdivided in a symptomatic and asymptomatic group on the basis of certain criteria.
Results: To obtain the intra and interexaminer reliability values, the Cohen's kappa, the percentage agreement, bias-adjusted kappa (BAK) and prevalence-adjusted bias-adjusted kappa (PABAK) were used. The mean Cohen's kappa did not exceed the value of 0.081. Only the percentage agreement of the symptomatic group did exceed the minimum level of 80%. When kappa was positive, the PABAK was markedly higher than kappa, and when kappa was negative the PABAK was only slightly higher than kappa. There were only small differences between kappa and BAK.
Conclusion: The Gillet test, as performed in this study, does not appear to be reliable.
Key indexing terms: reliability study; Cohen's kappa; sacroiliac joint.
Correlation and quantification of projected 2-D radiographic images with actual 3-D y-axis vertebral rotations.
Roger Coleman DC, Bert Bernard, Deed Harrison, DC, and Sanghak Harrison, DC.
Background: Historically, measurement of 2-D radiographic images on the anteroposterior radiograph has been made to assess 3-D y-axis vertebral rotations.
Objectives: To correlate and quantify measurements of the projected 2-D radiographic image with the degree of 3-D y-axis rotation.
Study design: A computer model was positioned in a simulated x-ray beam. Points of model contact with the simulated beam were projected onto a line in the neutral position and the first seven degrees of both positive and negative y-axis rotation utilizing two different axes of rotation. A larger model, a shape-altered model and a decreased source-object-distance model were also studied.
Results: 3-D y-axis rotation of vertebrae causes an off-center displacement of the 2-D projected lamina junction in relation to the projected vertebral body. The magnitude of displacement increases with increasing degrees of rotation. In our model there is no clinically significant difference in the amount of the projected off-center displacement of the lamina junction between either of our two chosen axes of rotation. However, significant differences in the projected offset were found between vertebrae with the same degree of rotation as a result of changes in vertebral shape, size and positioning. The projected lamina junction off centering at a given rotation is quantified for our model.
Conclusion: Use of millimetric measurement of the projected lamina offset on the anteroposterior radiograph is an inaccurate method for the assessment of the degree of 3-D y-axis vertebral rotation.
Key indexing terms: vertebrae; radiography; biomechanics.
Possible manifestation of temporomandibular joint dysfunction on chiropractic cervical x-ray studies.
Gary Knutson, DC and Moses Jacob, DC.
Objective: To show that biomechanical alterations toward and away from normal on x-ray studies may be the result of changes in temporomandibular joint dysfunction, and to discuss possible neurological explanations for this phenomenon.
Clinical features: Two patients are discussed: one suffered from migraine headache symptoms; the second suffered from chronic hypomobility of mandibular opening, dizziness, headache and neck pain and stiffness. In both patients, mensuration changes in different types of cervical x-ray studies were noted in conjunction with exacerbation of and elimination of temporomandibular joint dysfunction.
Intervention: Co-management of these cases was done with dental professionals. Chiropractic treatment included vectored/linear, upper cervical, high-velocity, low-amplitude chiropractic manipulation of the atlas vertebra, diversified manipulation, myofascial therapy, stretch and spray procedures and soft tissue manual techniques.
Conclusion: Temporomandibular joint dysfunction may cause cervical muscular and spinal biomechanical changes which may become visible and change on x-ray examination. Further investigation into this phenomenon is recommended.
Key indexing terms: temporomandibular joint dysfunction; chiropractic manipulation; radiography; dentistry.
Precision and accuracy of an electrogoniometer.
Henrik Christensen, DC, MD. Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
Background: Spinal range-of-motion has been studied using a variety of different methods. One electrogoniometer has been used as a noninvasive, reliable and accurate method. The accuracy and precision of this device has not been sufficiently documented.
Objective: To evaluate the precision and accuracy of an electrogoniometer in comparison with two manual protractors. Study design: The present study investigated the precision and accuracy of an electrogoniometer (OSI CA 6000).
Methods: The precision and accuracy of the electrogoniometer were determined by a series of tests against two manual protractors. Six different movement directions were tested and 4 or 5 different angles for a given movement direction were evaluated.
Results: The precision of the electrogoniometer was found to be +/- 0.1 for four different angles (10 degrees, 20 degrees, 40 degrees and 60 degrees) in six different movement directions (flexion, extension, left lateral flexion, right lateral flexion, left rotation and right rotation). The accuracy was tested by comparing both manual protractors with the electrogoniometer. Substantial disagreement for 27 out of 28 dataset were found. In only one dataset was their agreement between the two manual protractors and the electrogoniometer. The mean differences were in the interval 2.0-11.5% between the electrogoniometer and the protractors.
Conclusion: The electrogoniometer evaluated has a very high precision when range-of-motion measurements are made. However, the accuracy of the device is less than acceptable.
Key indexing terms: range-of-motion; accuracy; precision; validity; electrogoniometer.
Relationship between techniques taught and practice behavior: education and clinical correlation.
Angela Leone, DC.
Objective: This study was undertaken to determine the relationship between the time spent teaching various manual procedures in each of two different chiropractic colleges and the actual practice of those procedures in the graduate clinical environment of the doctors involved.
Methods: A simple questionnaire instrument was constructed to assess the frequency of use of nine different manual evaluation treatment procedures. All graduates from the two chiropractic colleges in the State of Texas, who obtained their license between 1988 and 1993, were polled. Reliability was studied by polling twice the first thirty qualified respondents and was found to be acceptable. The college curriculum with respect to the techniques studied was compared to the perceived use of the various techniques by the graduates surveyed.
Results: A total of 4/322 (70%) surveys were returned for consideration. Of these, 197 met all of the inclusion/exclusion criteria, and were assessed as part of the sample. Significant differences were found between the colleges with respect to perceived practitioner use of Activator (chi square=14.247, p=0.004), Thompson technique (chi square 57.702, p=0.000), Gonstead (chi square=52.173, p=0.000) and flexion distraction (chi square=29.424, p=0.000).
Conclusion: Data from this research provides evidence that a relationship does exist between manual procedures taught in two different chiropractic colleges and the perceived use of those procedures in actual clinical practice. Implications of this relationship are discussed.
Key indexing terms: chiropractic; education; practice behavior.
The ability to reproduce the neutral zero position of the head.
Henrik Christensen, DC, MD, Niels Nilsson, DC, MD. Odense, Denmark.
Objective: To determine how precisely asymptomatic subjects can reproduce a neutral zero position of the head.
Study design: Repeated measures of the active cervical neutral zero position.
Setting: Institute of Medical Biology (Center of Biomechanics) at Odense University.
Participants: 38 asymptomatic students from the University of Odense, male/female ratio: 20/18, mean age 24.3 years (range 20-30 years).
Intervention: Measurements of the location of the neutral zero head position using the electrogoniometer CA-6000 spine motion analyzer. Each subject's neutral zero position with eyes closed was measured three times. The device gives the localization of the neutral zero as coordinates in three dimensions (x,y,z) corresponding to the three motion planes.
Results: The mean difference from neutral zero in three motion planes was found to be 2.7 degrees in the sagittal plane, 1.0 degrees in the horizontal plane and 0.65 degrees in the frontal plane.
Conclusion: We found that young adult asymptomatic subjects are very good at reproducing the neutral zero position of the head. This suggests the existence of some advanced neurological control mechanisms.
Key indexing terms: cervical spine; range-of-motion; proprioception.
The incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache.
Stuart Wight, DC, Neil Osborne, DC, and Alan Breen, DC, PhD.
Background: The clinical significance of the ponticulus posticus (PP) is far from clear. It has been associated with headaches, Barr-Lieou syndrome, photophobia and migraine. There is, however, little epidemiological evidence for this.
Objective: This study investigated the relationship of ponticulus posticus on x-ray and headache symptoms in a series of chiropractic patients.
Methods: Eight hundred and ninety-five patients who visited a chiropractic clinic for the first time and whose conditions required cervical spine x-rays were studied. Complaints were categorized as: migraine with aura, migraine without aura, cervicogenic headache, neck pain only, and other conditions. The presence or absence of the PP (whether partial or complete) was determined using a lateal cervical film and noted as a positive or negative finding. The data were analyzed by frequency analysis and Pearson's chi-square test.
Results: Forty-six percent of the sample were males and the predominant complaint was neck pain (33%). Most patients were in the fourth decade of life. The frequencies of the other complaints were: migraine with aura (7%), migraine without aura (4%), cervicogenic headache (22%) other conditions (33%). There was an 18% prevalence of PP. This finding was significantly associated with migraine without aura (c2 = 4.97; p = 0.03) and not with any other conditions.
Conclusion: In a chiropractic patient population which required cervical x-rays, there was a significant association between PP and migraine without aura, with an odds ratio of 2.19:1 in favor of this complaint being present with the osseous anomaly. The mechanism for this remains obscure but may be related to ischemic compression of the vertebral artery or by dural tension at the craniocervical junction.
Key indexing terms: migraine; basilar artery insufficiency; chiropractic; migraine headache; cervical vertebrae.
Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disc herniation.
Craig Morris, DC.
Objective: To describe the non-surgical treatment of acute S1 radiculopathy from a large (12x12x13mm) L5-S1 disc herniation.
Clinical features: 31-year-old male with severe lower back pain and pain, paraesthesia and plantar flexion weakness of the left leg. His symptoms began five days before the initial visit and progressed despite NSAID and analgesic medication. An absent left Achilles reflex, left S1 dermatome hypesthesia, and left gastrocnemius/soleus weakness was noted. MRI demonstrated a large L5-S1 disc herniation.
Intervention and outcome: Initial treatment included McKenzie protocol press-ups to reduce and centralize symptoms, nonloading exercise for cardiovascular fitness, and lower leg isotonic exercises to prevent atrophy. Counseling was provided to reduce abnormal illness behavior risk. Later, flexion distraction and side-posture manipulation was provided to increase joint function. Sensory motor training, trunk stabilization exercises and trigger point therapy was also utilized. He returned to modified work 27 days after symptom onset. A follow-up, comparative MRI was unchanged. He was discharged as asymptomatic (zero rating on both Oswestry and NPS) after 50 days and 20 visits, although the left S1 reflex remained absent. Reassessment 169 days later revealed neither significant symptoms nor lifestyle restrictions.
Conclusion: This case demonstrates the potential benefit of a chiropractic rehabilitation strategy utilizing multimodal therapy for lumbar radiculopathy associated with disc herniation.
Key indexing terms: chiropractic; intervertebral disc; rehabilitation; lumbar vertebrae.
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