[Show abstract][Hide abstract] ABSTRACT: Cervical translatoric spinal manipulation (TSM) techniques have been suggested as a safer alternative to cervical thrust rotatory techniques. The objective of this study was to determine the effect of three C5-C6 non-thrust TSM techniques on vertebral artery (VA) lumen diameter (LD) and two blood flow velocity parameters. The two-tailed research hypothesis was that the TSM techniques would result in a significant change (increase or decrease) in blood flow velocity and arterial LD at the C5-C6 intertransverse portion of the VA.
In a sample of 30 subjects representative of a clinical population, color-coded duplex Doppler diagnostic ultrasound imaging was used to collect data on LD, peak systolic velocity (PSV), and end diastolic velocity with the cervical spine positioned in neutral and in three different manipulation positions. Pair-wise mean differences between measurements at baseline (neutral position) and in all three manipulation positions were analyzed using two-tailed paired t-tests with alpha set at 0·05.
Of the 18 paired comparisons, there were four statistically significant differences between measurements in the neutral position and a manipulation position, three concerning LD and one PSV.
The three significant differences in LD ranged from 4·6 to 3·2% and were not associated with changes in blood flow velocity. The one significant change in PSV was only 6·6 cm/s. A value that still greatly exceeded the end diastolic velocity. No subject experienced symptoms associated with VA compromise. This study has provided evidence for the safety of the three lower cervical non-thrust TSM techniques on the current population studied. Further study is required on thrust versus non-thrust TSM techniques and on levels other than C5-C6.
The Journal of manual & manipulative therapy 05/2011; 19(2):84-90.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this case series was to explore the effects of tibio-femoral (TF) manual traction on pain and passive range of motion (PROM) in individuals with unilateral motion impairment and pain in knee flexion. Thirteen participants volunteered for the study. All participants received 6 minutes of TF traction mobilization applied at end-range passive knee flexion. PROM measurements were taken before the intervention and after 2, 4, and 6 minutes of TF joint traction. Pain was measured using a visual analog scale with the TF joint at rest, at end-range passive knee flexion, during the application of joint traction, and immediately post-treatment. There were significant differences in PROM after 2 and 4 minutes of traction, with no significance noted after 4 minutes. A significant change in knee flexion of 25.9°, which exceeded the MDC(95,) was found when comparing PROM measurements pre- to final intervention. While pain did not change significantly over time, pain levels did change significantly during each treatment session. Pain significantly increased when the participant's knee was passively flexed to end range; it was reduced, although not significantly, during traction mobilization; and it significantly decreased following traction. This case series supports TF joint traction as a means of stretching shortened articular and periarticular tissues without increasing reported levels of pain during or after treatment. In addition, this is the first study documenting the temporal aspects of treatment effectiveness in motion restoration.
The Journal of manual & manipulative therapy 03/2010; 18(1):29-36.
[Show abstract][Hide abstract] ABSTRACT: This study examined the effect of translatoric spinal manipulation (TSM) on cervical pain and cervical active motion restriction when applied to upper thoracic (T1-T4) segments. Active cervical rotation range of motion was measured re- and post-intervention with a cervical inclinometer (CROM), and cervical pain status was monitored before and after manipulation with a Faces Pain Scale. Study participants included a sample of convenience that included 32 patients referred to physical therapy with complaints of pain in the mid-cervical region and restricted active cervical rotation. Twenty-two patients were randomly assigned to the experimental group and ten were assigned to the control group. Pre- and post-intervention cervical range of motion and pain scale measurements were taken by a physical therapist assistant who was blinded to group assignment. The experimental group received TSM to hypomobile upper thoracic segments. The control group received no intervention. Paired t-tests were used to analyze within-group changes in cervical rotation and pain, and a 2-way repeated-measure ANOVA was used to analyze between-group differences in cervical rotation and pain. Significance was accepted at p = 0.05. Significant changes that exceeded the MDC(95) were detected for cervical rotation both within group and between groups with the TSM group demonstrating increased mean (SD) in right rotation of 8.23 degrees (7.41 degrees ) and left rotation of 7.09 degrees (5.83 degrees ). Pain levels perceived during post-intervention cervical rotation showed significant improvement during right rotation for patients experiencing pain during bilateral rotation only (p=.05). This study supports the hypothesis that spinal manipulation applied to the upper thoracic spine (T1-T4 motion segments) significantly increases cervical rotation ROM and may reduce cervical pain at end range rotation for patients experiencing pain during bilateral cervical rotation.
The Journal of manual & manipulative therapy 02/2008; 16(2):93-9.
[Show abstract][Hide abstract] ABSTRACT: The currently most plausible pathophysiologic theory for the etiology of pain in patients with patellofemoral pain syndrome involves abnormal mechanical stress to the patellofemoral joint. At this time, there is no consensus nor is there a sufficient body of research evidence to guide management of patients with patellofemoral pain syndrome. This means that clinicians have to rely to some extent on a mechanism-based approach. Decreased quadriceps flexibility and muscular endurance have been identified as possibly relevant impairments in patients with patellofemoral pain syndrome. Surgical anterior translation of the tibial tuberosity with the Maquet procedure has a proven positive effect on patellofemoral contact forces. This case series studied the effects of a physical therapy management approach that included translating the tibia anteriorly while performing open kinetic chain quadriceps training and manual muscle stretching of the rectus femoris muscle. Outcome measures used included the numeric pain rating scale and goniometric measurement of rectus femoris muscle length in a standardized test position. Anterior tibial translation reduced pain during both interventions and also produced clinically and statistically significant pre- to post-intervention improvements in pain during manual muscle testing and rectus femoris length testing in addition to statistically significant pre- to post-intervention increases in rectus femoris muscle length. The results of this quasi-experimental study indicate the need for future experimental study. Future study should include functional in addition to impairment-based outcome measures, standardization and blinding for the rectus femoris muscle length test (should future researchers chose to again use this outcome measure), a pilot study establishing reliability of outcome measures collected by the therapist, younger subjects, and the collection of longer-term outcome data.
The Journal of manual & manipulative therapy 02/2007; 15(4):216-24.
[Show abstract][Hide abstract] ABSTRACT: Some physical therapists consider the report of dizziness at end-range cervical extension when coupled with side-bending and rotation to the same side (coupled lower cervical rotation in extension) to be a positive sign of vertebral artery compromise. However, degenerative changes and associated movement abnormalities in cervical motion segments may also produce dizziness. The use of mid-line translatoric joint mobilization in the presence of limited active cervical motion that is accompanied by dizziness during cervical extension, rotation, and coupled rotation in extension has not been addressed in the current literature. This case report describes the examination, evaluation, diagnosis, intervention, and outcomes for a 64-year-old woman who presented with limited cervical mobility and the complaint of dizziness during performance of these movements. Examination included a clinical differentiation process to determine the cause of the movement-related dizziness. Examination findings included increased translatoric joint play, tenderness, and reproduction of dizziness at the C4-C6 segments and decreased translatoric joint play at the C1-C4 and C7-T4 motion segments. Intervention included movement re-education and application of translatoric joint mobilization to the hypomobile segments. After 8 visits, there was complete resolution of dizziness during all active cervical movements and improved cervical mobility, as documented with the CROM. This case report demonstrates that clinical symptoms consistent with cervicogenic dizziness and limited cervical mobility may be treated safely and effectively using translatoric joint mobilization techniques. Confirmatory diagnostic ultrasound analysis of the vertebral artery revealed no compromise in flow velocity during the application of these translatoric mobilization techniques.
The Journal of manual & manipulative therapy 06/2006; 14(3):140-151.