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Immediate Effects of Cervical Manipulation for Mechanical Neck Pain
Viviane Maduro de Camargo, PT, DO, et al.
Objective: The purpose of this study was to identify the immediate effects of a manipulation of C5/C6 level on electromyography (EMG) of the deltoid muscle and in pressure pain thresholds (PPTs) in patients with mechanical neck pain.
Methods: Thirty-seven subjects with mechanical neck pain were randomly divided into two groups: a manipulative group, which received a cervical spine manipulation targeted to C5/C6 segment; and a control group, which did not receive any procedure. Outcomes were EMG data of the deltoid muscle (rest, isometric contraction for 5 or 30 seconds, and isotonic contraction) and PPT over upper trapezius and deltoid muscles and C5 spinous process. They were assessed before and 5 minutes after treatment by a blinded assessor. A three-way repeated-measures analysis of variance was used to examine the effects of the manipulation.
Results: A significant group time interaction for MF at the beginning of isometric contraction for 30 seconds (F = 7.957, P = .006) was also found: the manipulative group experienced a greater increase in MF at the beginning of the isometric contraction than did the control group. A significant group time interaction was also found for root mean square during isometric contraction for 30 seconds (P = .003); however, changes were small. Patients within the manipulative group experienced an increase on PPT over the deltoid (P = .010) and C5 spinous process (P = .025), but not over upper trapezius (P = .776).
Conclusions: Manipulation at C5/C6 level in the study participants seemed to increase EMG amplitude signal and fatigue resistance in a nonspinal (deltoid) muscle innervated by the same segment in patients with mechanical neck pain. However, these changes were relative small. An increase on PPT over those tissues innervated by the manipulated segment was also found after the manipulative procedure.
Kinematic Analysis of the Lumbar Spine by Digital Videofluoroscopy
Byung Woo Lee, MD, DC, PhD, et al.
Objectives: The purpose of this study was to use digital videofluoroscopy to identify motion patterns of the lumbar spine during coronal movement in asymptomatic (normal) subjects and patients with herniated nucleus pulposus (HNP).
Methods: Videofluoroscopic lumbar coronal motion was recorded in 18 asymptomatic volunteers and nine patients with HNP. Measurements were made while patients bent laterally and rotated toward the right and left from a sitting position and then returned to their original position. Direction and degree of extension in the coronal plane at each motion segment and sacral descent were measured. Through the motion analysis software, the coupled pattern with lateral bending and rotation was analyzed in the asymptomatic subjects and patients with HNP.
Results: Lateral flexion movement was coupled with contralateral extension and ipsilateral sacral descent, but with a different rotation pattern. Rotation movement was coupled with ipsilateral extension, ipsilateral sacral descent, and ipsilateral spinous process rotation. Patients with HNP and asymptomatic subjects had similar coupled patterns, but differences in amount of motion.
Conclusions: Digital videofluoroscopy showed coupled patterns during the lateral bending and rotation movements.
Validity of the Straight-Leg-Raise Test for Patients With Sciatic Pain
Francesco Capra, PT, et al.
Objective: The aim of this retrospective study was to assess validity of the straight-leg-raise (SLR) test using magnetic resonance imaging (MRI) results as a reference standard in a group of patients with L4-L5 and L5-S1 lumbar-herniated disks and sciatic pain. The relationship between diagnostic accuracy of this test, age classes, and grade of lumbar disk displacement was investigated.
Methods: The charts of 2,352 patients with sciatic pain with/without lumbar pain were examined. Results of the SLR were then compared with previous spinal MRI. A 2 2 contingency table was created, and analysis of sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio, likelihood ratio (LR), and receiver operating characteristic (ROC) curve was carried out. Homogeneous age classes were created to compare them statistically.
Results: Magnetic resonance imaging findings showed lumbar disk herniation (LDH) in 1,305 patients. Of these subjects, 741 were positive on SLR testing. Sensitivity was 0.36, whereas specificity was 0.74. Positive and negative predictive values were 0.69 and 0.52, respectively. Positive LR was 1.38, and negative LR was 0.87. Diagnostic odds ratio was 1.59, and ROC analysis showed an area under the curve (AUC) of 0.596. The AUC decreased from 0.730 in the 16- to 25-year subgroup to 0.515 in the 76- to 85-year subgroup. Similar results were obtained in subjects with LDH and nerve root compression.
Conclusions: Our results indicate low accuracy of the SLR in diagnosis of LDH if compared with MRI results. The discriminative power of the SLR seemed to decrease as age increased; thus, positive and negative results may be less conclusive in older patients.
Interexaminer Reliability of Supine Leg Checks for Discriminating Leg-Length Inequality
H. Charles Woodfield, RPh, DC, et al.
Objective: The purpose of this study was to quantify interexaminer reliability of a standardized supine leg check procedure used to screen for leg-length inequality.
Methods: Two doctors of chiropractic used a standardized supine leg check procedure to examine 50 volunteers for leg-length inequality. The order of examination was randomized. The side and magnitude of leg-length inequality were determined to the nearest 1/8 inch. Subjects and examiners were blinded. Interexaminer reliability was assessed with a Bland-Altman plot, tolerance table of absolute differences, a quadratic weighted K statistic for quantitative scores, and a Gwet's first-order agreement coefficient for dichotomous ratings.
Results: The quadratic weighted K statistic to quantify the reliability of the rating scale was 0.44 (95% confidence interval, 0.21-0.67), indicating moderate reliability. The two examiners agreed exactly 32% of the time, within 1/8 inch 58% of the time, within 3/16 inch 72% of the time, and within 3/8 inch 92% of the time. The Bland-Altman plot revealed possible heterogeneity in reliability that requires additional study. The examiners agreed on the presence of a leg-length inequality of at least 1/8 inch in 40 (80%) of 50 subjects (first-order agreement coefficient, 0.76), suggesting good agreement for this diagnostic category.
Conclusion: The examiners showed moderate reliability in assessing leg-length inequality at 1/8-inch increments and good reliability in determining the presence of a leg-length inequality.
Interrater Reliability of the Craniocervical Flexion Test in Asymptomatic Individuals
Ashokan Arumugam, MPT, et al.
Objective: The objective of this study was to evaluate interrater reliability of the craniocervical flexion test (CCFT) on asymptomatic subjects.
Methods: A cross-sectional repeated-measures study design was used. Thirty asymptomatic subjects (15 men and 15 women; mean age, 33.7 years; range, 22-48 years) were recruited for the study. Subjects were positioned in supine-lying with a pneumatic pressure sensor of the pressure biofeedback unit placed under the neck. Subjects performed three trials of craniocervical flexion with each trial consisting of five incremental stages (22, 24, 26, 28, and 30 mm Hg) guided through feedback from the pressure dial of the pressure biofeedback unit. All the trials were scored simultaneously by two raters. The outcome measure was the activation score - the maximum pressure (above baseline 20 mm Hg) that was achieved and held in a steady manner for 10 seconds. Intraclass correlation coefficient (ICC 3,1) was analyzed using the two repeated scores out of three trials for either rater.
Results: Interrater reliability (ICC) for the CCFT was 0.91 (95% confidence interval, 0.83-0.96). There was a reasonable agreement on the Bland-Altman plot confirming high reliability of the test.
Conclusion: The study has shown high interrater reliability when two raters simultaneously scored the CCFT trials in asymptomatic individuals.
Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Pilot Study
Jerrilyn Cambron, DC, PhD, et al.
Objectives: The purpose of this pilot study was to investigate the feasibility of a randomized clinical trial of shoe orthotics for chronic low back pain.
Methods: The study recruited 50 patients with chronic low back pain through media advertising in a Midwestern suburban area. Medical history and a low back examination were completed at a chiropractic clinic. Subjects were randomized to either a treatment group receiving custom-made shoe orthotics or a wait-list control group. After six weeks, the wait-list control group also received custom-made orthotics. This study measured change in perceived pain levels (Visual Analog Scale) and functional health status (Oswestry Disability Index) in patients with chronic low back pain at the end of six weeks of orthotic treatment compared with no treatment and at the end of 12 weeks of orthotic treatment.
Results: This study showed changes in back pain and disability with the use of shoe orthotics for six weeks compared with a wait-list control group. It appears that improvement was maintained through the 12-week visit, but the subjects did not continue to improve during this time.
Conclusions: This pilot study showed that the measurement of shoe orthotics to reduce low back pain and discomfort after six weeks of use is feasible. A larger clinical trial is needed to verify these results.
JMPT abstracts appear in DC with permission from the journal. Due to space restrictions, we cannot always print all abstracts from a given issue. Visit www.journals.elsevierhealth.com/periodicals/ymmt for access to the complete May 2011 issue of JMPT.
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