Manual therapy
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Randomized Controlled Trial Comparative Study
Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: a randomized controlled trial.
There is evidence that temporomandibular disorder (TMD) may be a contributing factor to cervicogenic headache (CGH), in part because of the influence of dysfunction of the temporomandibular joint on the cervical spine. The purpose of this randomized controlled trial was to determine whether orofacial treatment in addition to cervical manual therapy, was more effective than cervical manual therapy alone on measures of cervical movement impairment in patients with features of CGH and signs of TMD. In this study, 43 patients (27 women) with headache for more than 3-months and with some features of CGH and signs of TMD were randomly assigned to receive either cervical manual therapy (usual care) or orofacial manual therapy to address TMD in addition to usual care. ⋯ The group that received orofacial treatment in addition to usual care showed significant reduction in all aspects of cervical impairment after the treatment period. These improvements persisted to the 6-month follow-up, but were not observed in the usual care group at any point. These observations together with previous reports indicate that manual therapists should look for features of TMD when examining patients with headache, particularly if treatment fails when directed to the cervical spine.
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Accurate palpation of lumbar spinous processes (SPs) is a key component of spinal assessment. It is also vital for the accurate measurement of spinal motion when using external skin marker-based measurement systems, which are being increasingly used to understand low back disorders and their management. The aim was to assess the accuracy of lumbar spinous process (SP) palpation using positional magnetic resonance imagery (MRI) (pMRI). ⋯ For each position, an MRI marker was attached over the SP and pMRI scanning was conducted. The position of the marker in relation to L4 on the MRI images was visually inspected, and measurements (mm) of the vertical distance from the superior/inferior aspect of the marker to the superior/inferior aspect of the L4 SP were used to determine palpation accuracy. 71% of Markers were correctly placed over the L4 SP. The magnitude of error for incorrectly placed markers was small, with the largest median distance of 2.7 mm (interquartile range (IQR) 0-3.6) recorded for one of the therapists palpating in prone lying. 100% of markers were correctly placed either on L4 or within one SP in height. pMRI is useful for investigating the accuracy of SP palpation in positions relevant to clinical and research practice.
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Randomized Controlled Trial Comparative Study
The effectiveness of Long's manipulation on patients with chronic mechanical neck pain: a randomized controlled trial.
Long's manipulation (LM) is a representative Chinese manipulation approach incorporating both spinal manipulation and traditional Chinese massage (TCM) techniques. This randomized controlled trial (RCT) aimed to compare the immediate and short-term relative effectiveness of LM to TCM on patients with chronic neck pain. Patients were randomly assigned to either LM group or TCM group. ⋯ LM group achieved significantly greater improvement than TCM group in pain intensity (p < 0.001), neck disability (p = 0.049) and satisfaction (p < 0.001) up to 3-month follow-up. There was no significant difference in improvements in CV angle and most of cervical ROM between groups (p = 0.169 ∼ 0.888) with an exception of flexion at 3-month follow-up (p = 0.005). This study shows that LM could produce better effects than TCM in relieving pain and improving disability in the management of patients with chronic mechanical neck pain.
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The cervical spine exhibits considerable mobility, especially in axial rotation. Axial rotation exerts stress on anatomical structures, such as the vertebral artery which is commonly assessed during clinical examination. The literature is rather sparse concerning the in vivo three-dimensional segmental kinematics of the cervical spine. ⋯ For the lower levels, axial rotation was found to be maximal at C4-C5 level (5.5 ± 1.0°) coupled with lateral flexion to the same side (-4.0 ± 2.5°). Extension was associated at levels C2-C3, C3-C4 and C4-C5, whereas flexion occurred between C5-C6 and C6-C7. Coupled lateral flexion occurred to the opposite side at the upper cervical spine and to the same side at the lower cervical spine.