PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY
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1999 - Vol. 7, No. 3
* this issue only available in PDF format
The Effect of Joint Manipulation Techniques on Active Range of Motion in the Mid-Thoracic Spine of Asymptomatic Subjects
Dennis Gavin MSc, PT, MTC
Abstract: This study assesses the effect of the manipulation of restricted thoracic spine segments on thoracic active range of motion (AROM). Range of motion (ROM) is measured routinely to assess joint mobility, tissue extensibility, and function of the spine and the extremities. Manipulation has been used to restore normal joint mechanics and increase ROM. However, no research specifically shows that ROM in the thoracic spine increases after spinal manipulation. Seventy- eight healthy subjects (29 male, 49 female), ages 18-44, were divided into three categories. Group I was the control, group 2 received mobility testing only, and group 3 received mobility testing and joint manipulation to a restricted segment. All subjects were pre-tested for AROM of T3-T8; then either rested, received mobility tests, or were manipulated, after which post-test measurements were performed. Forward bending and side bending right and left were measured. In a comparison of pre-treatment versus post-treatment AROM, a significant difference was seen in side bending to the left only. This demonstrates that one session of manipulation techniques can influence AROM in the mid-thoracic spine.
The Journal of Manual & Manipulative Therapy Vol. 7 No.3 (1999 ), 114 - 122
Dizziness Following Whiplash Injury: A Neuro-Otological Study in Manual Therapy Practice and Therapeutic Implication
Rob A.B. Oostendorp Rob A.B., PhD, PT, MT Aart A.J.M. VanEupen, PT, MT Jos M.M. VanErp, PT, MT Hans W.H. Elvers, MScMed, BScStat
Abstract: Background and Aim: Dizziness or vertigo is a frequent complication of whiplash injury and reported in 40% -80% of cases. The term dizziness covers a wide range of symptoms. Characteristics of the neuro-otological signs in patients with whiplash associated disorders (WAD) remains a subject of debate. It has been reported that whiplash injury is a cause of benign paroxysmal positional vertigo (BPPV). The aim of the present study was to document the incidence of BPPV in whiplash-patients referred for manual therapy. Methods: All patients with whiplash injuries referred by a physician (60%) or by a medical specialist (40%), were examined following a standard protocol (history-taking and neuro-otological assessment). A key diagnostic manoeuvre for BPPV is the Dix and Hallpike positional test. Subjects: In a five-year period, 368 patients were referred. Based on four inclusion criteria, 273 patients were included in the study. All gave their informed consent. Statistical Analysis: Non-parametric statistics are used, based on the measurement level of the tests (dichotomous and ordinal level). Results: BPPV was suspected as a result of history-taking in 96 (35%) of 273 patients. A positive Dix and Hallpike response was seen in 68 (25%) of 273 patients; 56 of these patients were assessed as typical (positional vertigo and rotatory nystagmus) and 12 patients as atypical (positional dizziness and no rotatory nystagmus). Conclusion: The incidence of suspected BPPV is anamnestically 35% and clinically 25%. There is a discrepancy between neuro-otological signs and symptoms. The prognosis of BPPV is considered good with peripheral and central adaptation within 6 to 12 weeks. No spontaneous recovery occurred in our patients. Discussion: The results of this study highlight the need for the manual therapist to differentiate between patients with whiplash with a clinical entity (for example, [suspected] BPPV) and patients with whiplash injury without a clinical entity. Therapeutic implications for both groups of whiplash patients are given.
The Journal of Manual & Manipulative Therapy Vol. 7 No.3 (1999 ), 123 - 130
Neuroanatomical Review of Visceral Pain
Stuart Robertson, MSc, BSc, B.Ed (Hons.)
Abstract: Visceral afferent information is processed centrally by the nervous system. The central connections of these afferents are widespread. Although the encoding of visceral pain is still co creating much debate, evidence exists for mechanisms of central sensitization and mechanisms of referred pain to somatic structures, leading to possible trophic changes in these structures. The autonomic nervous system innervates the viscera. As with the somatic nervous system, it too is vulnerable in certain areas to compromise, within the thoracic, abdominal and pelvic cavities for example. If the sympathetic nervous system is sensitized then alterations in sympathetic outflow could lead to trophic alteration in target tissue, as well as the maintenance of pain states. If, at a physical level, manual therapists are to evaluate these central and sympathetic changes that may take place due to sensitized visceral and sympathetic input in the generation and maintenance of pain, then a physical assessment of the visceral and supporting fascial network must be made in the management of chronic pain states.
The Journal of Manual & Manipulative Therapy Vol. 7 No.3 (1999 ), 131 - 140
Lumbar Spinal Stenosis: A Literature Review
Jeff Wencel PT Kenneth A. Olson MSc, PT, OCS
Abstract: This paper describes the etiology and clinical manifestations of lumbar spinal stenosis (LSS); discusses diagnosis, prognosis, and intervention; and addresses outcome studies and their implications in managing patients with lumbar spinal stenosis. LSS is a condition involving narrowing of the central spinal canal, lateral recesses, or intervertebral foramina; it is the most commonly diagnosed degenerative process associated with aging. Neurogenic intermittent claudication is a common clinical manifestation of LSS that must be differentiated from vascular claudication of the lower extremities. Although surgery is commonly performed in treating LSS, some evidence exists to support the use of a conservative approach such as orthopaedic manual physical therapy. However, controlled clinical trials with large sample sizes are lacking to offer strong support for either conservative or surgical measures. This paper provides a rationale for a manual physical therapy and exercise approach in treating LSS. Future studies need to include comparative research involving different conservative approaches, and indications for surgical versus non- surgical management of LSS need to be more clearly defined and studied through randomized, controlled clinical trials.
The Journal of Manual & Manipulative Therapy Vol. 7 No.3 (1999 ), 141 - 148
* this issue only available in PDF format
