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Journal Cover Journal of Manipulative and Physiological Therapeutics
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0161-4754
   Published by Elsevier Homepage  [3044 journals]
  • TENS-like Stimulation Downregulates Inflammatory Cytokines in a PC-12 Cell
    • Authors: Guy Sovak; Brian Budgell
      Pages: 381 - 386
      Abstract: Publication date: July–August 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 6
      Author(s): Guy Sovak, Brian Budgell
      Objectives The purpose of this study was to evaluate the effects of transcutaneous electrical nerve stimulation (TENS)–like stimulation on the expression of the proinflammatory cytokines tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6 in PC-12 cells, which are commonly used as neuronal cell models. Methods Nerve growth factor–differentiated PC-12 cells were exposed to electrical stimulation for 15 minutes at 1 mA, 200 μs, and 100 Hz. Cell lysate from stimulated and control cells was assayed for TNF-α, IL-1β, and IL-6. In 6 trials, cells were preincubated with the L-type ion channel blocker nicardipine. Cultured cells were also incubated with Alexa Fluor 488 and visualized by fluorescence microscopy to determine the nuclear vs cytoplasmic distribution of the p65 sub-unit of NF-κB Results Compared with control (unstimulated) cells, the stimulated cells had a downregulation of the assayed cytokines. However, preincubation with the L-type ion channel blocker nicardipine blocked this effect of stimulation. Additionally, it was noted that TENS-like stimulation promoted a relative sequestration of the p65 subunit of NF-κB in the cytoplasm vs the nucleus. Conclusions It appears that in this cell line and with these stimulation parameters, TENS-like stimulation attenuated the expression of the assayed proinflammatory cytokines, in part by promoting the relative sequestration of the p65 subunit of NF-κB in the cytoplasm, and that voltage-dependent calcium channels have a role in the cascade of events initiated by the TENS-like stimulation.

      PubDate: 2017-08-22T14:42:14Z
      DOI: 10.1016/j.jmpt.2017.03.008
  • Influence of Spinal Manipulative Therapy Force Magnitude and Application
           Site on Spinal Tissue Loading: A Biomechanical Robotic Serial Dissection
           Study in Porcine Motion Segments
    • Authors: Martha Funabashi; François Nougarou; Martin Descarreaux; Narasimha Prasad; Greg Kawchuk
      Pages: 387 - 396
      Abstract: Publication date: July–August 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 6
      Author(s): Martha Funabashi, François Nougarou, Martin Descarreaux, Narasimha Prasad, Greg Kawchuk
      Objective In order to define the relation between spinal manipulative therapy (SMT) input parameters and the distribution of load within spinal tissues, the aim of this study was to determine the influence of force magnitude and application site when SMT is applied to cadaveric spines. Methods In 10 porcine cadavers, a servo-controlled linear actuator motor provided a standardized SMT simulation using 3 different force magnitudes (100N, 300N, and 500N) to 2 different cutaneous locations: L3/L4 facet joint (FJ), and L4 transverse processes (TVP). Vertebral kinematics were tracked optically using indwelling bone pins, the motion segment removed and mounted in a parallel robot equipped with a 6-axis load cell. The kinematics of each SMT application were replicated robotically. Serial dissection of spinal structures was conducted to quantify loading characteristics of discrete spinal tissues. Forces experienced by the L3/L4 segment and spinal structures during SMT replication were recorded and analyzed. Results Spinal manipulative therapy force magnitude and application site parameters influenced spinal tissues loading. A significant main effect (P < .05) of force magnitude was observed on the loads experienced by the intact specimen and supra- and interspinous ligaments. The main effect of application site was also significant (P < .05), influencing the loading of the intact specimen and facet joints, capsules, and ligamentum flavum (P < .05). Conclusion Spinal manipulative therapy input parameters of force magnitude and application site significantly influence the distribution of forces within spinal tissues. By controlling these SMT parameters, clinical outcomes may potentially be manipulated.

      PubDate: 2017-08-22T14:42:14Z
      DOI: 10.1016/j.jmpt.2017.05.003
  • The Effect of Augmented Feedback and Expertise on Spinal Manipulation
           Skills: An Experimental Study
    • Authors: Mégane Pasquier; Charlène Cheron; Claude Dugas; Arnaud Lardon; Martin Descarreaux
      Pages: 404 - 410
      Abstract: Publication date: July–August 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 6
      Author(s): Mégane Pasquier, Charlène Cheron, Claude Dugas, Arnaud Lardon, Martin Descarreaux
      Objectives The purpose of this study was to investigate the combined effect of augmented feedback and expertise on the performance and retention of basic motor learning spinal manipulation skills. Methods A total of 103 chiropractic students with various training expertise were recruited for the study. Participants were evaluated at baseline, immediately after trials of augmented feedback practice and 1 week later. During all 3 assessments, students were asked to perform several trials of the same spinal manipulation, for which the maximum preload force, onset of thrust, thrust duration, force and peak force, thrust duration, rate of force application, and any drop in preload force were calculated. The constant error, absolute error, and variable error were calculated for the 3 experimental blocks of trials. Results Results confirmed that augmented feedback training modified several biomechanical parameters such as the rate of force application, the preload force, and the drop in preload force. The study also confirmed that many biomechanical parameters, including thrust duration and rate of force application, are modified with expertise but failed to identify any interaction effect between expertise and augmented feedback training effects. Conclusion The study determined that expertise did not influence how students performed after a session of augmented feedback training. The study also determined that augmented feedback related to the global performance can yield improvements in several basic components of the spinal manipulation task. These results should be interpreted considering basic motor learning principles and specific learning environments.

      PubDate: 2017-08-22T14:42:14Z
      DOI: 10.1016/j.jmpt.2017.03.010
  • An Observational Study on Recurrences of Low Back Pain During the First 12
           Months After Chiropractic Treatment
    • Authors: Christina Knecht; Barry Kim Humphreys; Brigitte Wirth
      Pages: 427 - 433
      Abstract: Publication date: July–August 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 6
      Author(s): Christina Knecht, Barry Kim Humphreys, Brigitte Wirth
      Objectives The purpose of this study was to investigate recurrence rate and prognostic factors in a large population of patients with low back pain (LBP) up to 1 year after chiropractic care using standardized definitions. Methods In Switzerland, 722 patients with LBP (375 male; mean age = 44.5 ± 13.8 years) completed the Numeric Rating Scale for pain (NRS) and the Oswestry Disability Index (ODI) before treatment and 1, 3, 6, and 12 months later (ODI up to 3 months). Based on NRS values, patients were categorized as “fast recovery,” “slow recovery,” “recurrent,” “chronic,” and “others.” In multivariable logistic regression models, age, sex, work status, duration of complaint (subacute: ≥14 days to <3 months; chronic: ≥3 months), previous episodes, baseline NRS, and baseline ODI were investigated as predictors. Results Based on NRS values, 13.4% of the patients were categorized as recurrent. The recurrent pattern significantly differed from fast recovery in duration of complaint (subacute: odds ratio [OR] = 3.3; chronic: OR = 10.1). The recurrent and chronic pattern significantly differed in duration of complaint (chronic: OR = 0.14) and baseline NRS (OR = 0.75). Conclusion Recurrence rate was low in this LBP patient population. The duration of complaint before treatment was the main predictor for recurrence. The fact that even subacute duration significantly increased the odds for an unfavorable course of LBP is of clinical relevance.

      PubDate: 2017-08-22T14:42:14Z
      DOI: 10.1016/j.jmpt.2017.03.005
  • Posture Alignment of Adolescent Idiopathic Scoliosis: Photogrammetry in
           Scoliosis School Screening
    • Authors: Patrícia Jundi Penha; Nárima Lívia Jundi Penha; Bárbarah Kelly Gonçalves De Carvalho; Rodrigo Mantelatto Andrade; Ana Carolina Basso Schmitt; Sílvia Maria Amado João
      Pages: 441 - 451
      Abstract: Publication date: July–August 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 6
      Author(s): Patrícia Jundi Penha, Nárima Lívia Jundi Penha, Bárbarah Kelly Gonçalves De Carvalho, Rodrigo Mantelatto Andrade, Ana Carolina Basso Schmitt, Sílvia Maria Amado João
      Objective The objective of this study was to describe the posture patterns of adolescents diagnosed with adolescent idiopathic scoliosis (AIS) in a scoliosis school screening (SSS). Methods Two-dimensional photogrammetry was used to assess the posture of 37 adolescents diagnosed with scoliosis (scoliosis group, SG) (Cobb angle ≥10°) and 76 adolescents with a false positive diagnosis (false positive group, FPG) (Cobb angle <10°, angle of trunk rotation ≥7°). In total, 2562 10- to 14-year-old adolescents were enrolled in the SSS, which was performed in public schools in the cities of Amparo, Pedreira, and Mogi Mirim in the state of São Paulo, Brazil. Their posture was analyzed using Postural Analysis Software. Continuous variables were tested using Student t test, and categorical variables were tested using a χ2 test. The SG, FPG, simple curve group, and double curve group were all compared. Bivariate analysis was used to identify associations between postural deviations and scoliosis. The adopted significance level was α = .05. Results The SG (2.7 ± 1.9°) had greater shoulder obliquity than the FPG (1.9 ± 1.4°) (P = .010), and this deviation was associated with scoliosis (odds ratio [95% CI] P = 1.4 [1.1-1.8] 0.011). The SG had asymmetry between the right- and left-side lower limb frontal angle, shoulder sagittal alignment, and knee angle. The double curve group (3 ± 1.7°) presented a greater value of the vertical alignment of the torso than the simple curve group did (1.9 ± 1°; P = .032). Conclusions Adolescents diagnosed with AIS in an SSS had greater shoulder obliquity and asymmetry between the right and left sides. Shoulder obliquity was the only postural deviation associated with AIS.

      PubDate: 2017-08-22T14:42:14Z
      DOI: 10.1016/j.jmpt.2017.03.013
  • Spinal Manipulative Therapy for Adolescent Idiopathic Scoliosis: A
           Systematic Review
    • Authors: Jean Théroux; Norman Stomski; Christine Dominique Losco; Christelle Khadra; Hubert Labelle; Sylvie Le May
      Pages: 452 - 458
      Abstract: Publication date: July–August 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 6
      Author(s): Jean Théroux, Norman Stomski, Christine Dominique Losco, Christelle Khadra, Hubert Labelle, Sylvie Le May
      Objective The purpose of this study was to perform a systematic review of clinical trials of spinal manipulative therapy for adolescent idiopathic scoliosis. Methods Search strategies were developed for PubMed, CINHAL, and CENTRAL databases. Studies were included through June 2016 if they were prospective trials that evaluated spinal manipulative therapy (eg, chiropractic, osteopathic, physical therapy) for adolescent idiopathic scoliosis. Data were extracted and assessed by 2 independent reviewers. Cochrane risk of bias tools were used to assess the quality of the included studies. Data were reported qualitatively because heterogeneity prevented statistical pooling. Results Four studies satisfied the inclusion criteria and were critically appraised. The findings of the included studies indicated that spinal manipulative therapy might be effective for preventing curve progression or reducing Cobb angle. However, the lack of controls and small sample sizes precluded robust estimation of the interventions’ effect sizes. Conclusion There is currently insufficient evidence to establish whether spinal manipulative therapy may be beneficial for adolescent idiopathic scoliosis. The results of the included studies suggest that spinal manipulative therapy may be a promising treatment, but these studies were all at substantial risk of bias. Further high-quality studies are warranted to conclusively determine if spinal manipulative therapy may be effective in the management of adolescent idiopathic scoliosis.

      PubDate: 2017-08-22T14:42:14Z
      DOI: 10.1016/j.jmpt.2017.03.009
  • Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions
    • Authors: Cheryl Hawk; Amy L. Minkalis; Raheleh Khorsan; Clinton J. Daniels; Dennis Homack; Jordan A. Gliedt; Julie A. Hartman; Shireesh Bhalerao
      Pages: 293 - 319
      Abstract: Publication date: June 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 5
      Author(s): Cheryl Hawk, Amy L. Minkalis, Raheleh Khorsan, Clinton J. Daniels, Dennis Homack, Jordan A. Gliedt, Julie A. Hartman, Shireesh Bhalerao
      Objective The purpose of this review was to evaluate the effectiveness of conservative nondrug, nonsurgical interventions, either alone or in combination, for conditions of the shoulder. Methods The review was conducted from March 2016 to November 2016 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered with PROSPERO. Eligibility criteria included randomized controlled trials (RCTs), systematic reviews, or meta-analyses studying adult patients with a shoulder diagnosis. Interventions qualified if they did not involve prescription medication or surgical procedures, although these could be used in the comparison group or groups. At least 2 independent reviewers assessed the quality of each study using the Scottish Intercollegiate Guidelines Network checklists. Shoulder conditions addressed were shoulder impingement syndrome (SIS), rotator cuff-associated disorders (RCs), adhesive capsulitis (AC), and nonspecific shoulder pain. Results Twenty-five systematic reviews and 44 RCTs met inclusion criteria. Low- to moderate-quality evidence supported the use of manual therapies for all 4 shoulder conditions. Exercise, particularly combined with physical therapy protocols, was beneficial for SIS and AC. For SIS, moderate evidence supported several passive modalities. For RC, physical therapy protocols were found beneficial but not superior to surgery in the long term. Moderate evidence supported extracorporeal shockwave therapy for calcific tendinitis RC. Low-level laser was the only modality for which there was moderate evidence supporting its use for all 4 conditions. Conclusion The findings of this literature review may help inform practitioners who use conservative methods (eg, doctors of chiropractic, physical therapists, and other manual therapists) regarding the levels of evidence for modalities used for common shoulder conditions.

      PubDate: 2017-08-02T14:19:04Z
      DOI: 10.1016/j.jmpt.2017.04.001
  • Correlation of Body Composition and Low Back Pain Severity in a
           Cross-Section of US Veterans
    • Authors: Casey S. Okamoto; Andrew S. Dunn; Bart N. Green; Lance R. Formolo; David Chicoine
      Pages: 358 - 364
      Abstract: Publication date: June 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 5
      Author(s): Casey S. Okamoto, Andrew S. Dunn, Bart N. Green, Lance R. Formolo, David Chicoine
      Objective Back pain is more prevalent in the obese, but whether back pain severity is directly correlated to obesity in veterans is unknown. We sought to determine if there was a correlation between body composition and low back pain severity in a sample of veterans. The hypothesis was that veterans with higher body mass index values would report higher low back pain severity scores. Methods This study was a retrospective chart review of 1768 veterans presenting to a Veterans Affairs chiropractic clinic with a chief complaint of low back pain between January 1, 2009 and December 31, 2014. Spearman’s rho was used to test for correlation between body composition as measured by body mass index and low back pain severity as measured by the Back Bournemouth Questionnaire. Results On average, the sample was predominantly male (91%), older than 50, and overweight (36.5%) or obese (48.9%). There was no correlation between body mass index and Back Bournemouth Questionnaire scores, r = .088, p < .001. Conclusions The majority of veterans with low back pain in this sample were either overweight or obese. There was no correlation between body composition and low back pain severity in this sample of veterans.

      PubDate: 2017-08-02T14:19:04Z
      DOI: 10.1016/j.jmpt.2017.03.003
  • Best Practices for Chiropractic Care for Older Adults: A Systematic Review
           and Consensus Update
    • Authors: Cheryl Hawk; Michael J. Schneider; Mitchell Haas; Paul Katz; Paul Dougherty; Brian Gleberzon; Lisa Z. Killinger; John Weeks
      Pages: 217 - 229
      Abstract: Publication date: May 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 4
      Author(s): Cheryl Hawk, Michael J. Schneider, Mitchell Haas, Paul Katz, Paul Dougherty, Brian Gleberzon, Lisa Z. Killinger, John Weeks
      Objective The purpose of this study was to update evidence-based recommendations on the best practices for chiropractic care of older adults. Methods The project consisted of a systematic literature review and a consensus process. The following were searched from October 2009 through January 2016: MEDLINE, Index to Chiropractic Literature, CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied and Complementary Medicine Database), Alt HealthWatch, Cochrane Database of Systematic Reviews, and Cochrane Registry of Controlled Trials. Search terms were: (manipulation, spinal OR manipulation, chiropractic OR chiropract*) AND (geriatric OR “older adult*”). Two reviewers independently screened articles and abstracts using inclusion and exclusion criteria. The systematic review informed the project steering committee, which revised the previous recommendations. A multidisciplinary panel of experts representing expertise in practice, research, and teaching in a variety of health professions serving older adults rated the revised recommendations. The RAND Corporation/University of California, Los Angeles methodology for a modified Delphi consensus process was used. Results A total of 199 articles were found; after exclusion criteria were applied, 6 articles about effectiveness or efficacy and 6 on safety were added. The Delphi process was conducted from April to June 2016. Of the 37 Delphi panelists, 31 were DCs and 6 were other health care professionals. Three Delphi rounds were conducted to reach consensus on all 45 statements. As a result, statements regarding the safety of manipulation were strengthened and additional statements were added recommending that DCs advise patients on exercise and that manipulation and mobilization contribute to general positive outcomes beyond pain reduction only. Conclusions This document provides a summary of evidence-informed best practices for doctors of chiropractic for the evaluation, management, and manual treatment of older adult patients.

      PubDate: 2017-08-02T14:19:04Z
      DOI: 10.1016/j.jmpt.2017.02.001
  • Reference Values for Human Posture Measurements Based on Computerized
           Photogrammetry: A Systematic Review
    • Authors: Ana Freire Macedo Ribeiro; Anke Bergmann; Thiago Lemos; Antônio Guilherme Pacheco; Maitê Mello Russo; Laura Alice Santos de Oliveira; Erika de Carvalho Rodrigues
      Pages: 156 - 168
      Abstract: Publication date: March–April 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 3
      Author(s): Ana Freire Macedo Ribeiro, Anke Bergmann, Thiago Lemos, Antônio Guilherme Pacheco, Maitê Mello Russo, Laura Alice Santos de Oliveira, Erika de Carvalho Rodrigues
      Objective The main objective of this study was to review the literature to identify reference values for angles and distances of body segments related to upright posture in healthy adult women with the Postural Assessment Software (PAS/SAPO). Methods Electronic databases (BVS, PubMed, SciELO and Scopus) were assessed using the following descriptors: evaluation, posture, photogrammetry, physical therapy, postural alignment, postural assessment, and physiotherapy. Studies that performed postural evaluation in healthy adult women with PAS/SAPO and were published in English, Portuguese and Spanish, between the years 2005 and 2014 were included. Results Four studies met the inclusion criteria. Data from the included studies were grouped to establish the statistical descriptors (mean, variance, and standard deviation) of the body angles and distances. A total of 29 variables were assessed (10 in the anterior views, 16 in the lateral right and left views, and 3 in the posterior views), and its respective mean and standard deviation were calculated. Reference values for the anterior and posterior views showed no symmetry between the right and left sides of the body in the frontal plane. There were also small differences in the calculated reference values for the lateral view. Conclusion The proposed reference values for quantitative evaluation of the upright posture in healthy adult women estimated in the present study using PAS/SAPO could guide future studies and help clinical practice.

      PubDate: 2017-08-02T14:19:04Z
      DOI: 10.1016/j.jmpt.2016.12.001
  • Information for Readers
    • Abstract: Publication date: July–August 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 6

      PubDate: 2017-08-22T14:42:14Z
  • A Multimodal Approach for Myofascial Pain Syndrome: A Prospective Study
    • Authors: María Segura-Pérez; M. Teresa Hernández-Criado; César Calvo-Lobo; Lorena Vega-Piris; Raquel Fernández-Martín; David Rodríguez-Sanz
      Abstract: Publication date: Available online 21 July 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): María Segura-Pérez, M. Teresa Hernández-Criado, César Calvo-Lobo, Lorena Vega-Piris, Raquel Fernández-Martín, David Rodríguez-Sanz
      Objective The purpose of this study was to analyze pain intensity in patients with myofascial pain syndrome (MPS) following a multimodal rehabilitation protocol. Methods A prospective study was carried out following the Template for Intervention Description and Replication criteria. Patients were recruited from the rehabilitation unit of a university hospital in Spain between 2009 and 2013. Patients were included if they had a medical diagnosis of MPS in any of the following regions: cervicobrachial (n = 102), lumbosacral (n = 30), elbow (n = 14), ankle and foot (n = 10), and temporomandibular jaw (n = 1). The multimodal rehabilitation protocol included myofascial trigger point dry needling, spray and stretching, Kinesio taping, eccentric exercise, and patient education. The protocol was applied for 4 weeks (5 sessions) for the active and/or latent myofascial trigger points in each body region. Pain intensity was measured by using the visual analog scale (VAS) immediately before beginning of the study and 1 week after completion of the protocol. Results The study sample comprised 150 patients (mean ± standard deviation age, 51.5 ± 1.19 years). Statistically significant differences were obtained for reduction in pain intensity (4 ± 2.03; P = .002). Clinically relevant reductions (VAS ≥30 mm; P < .001) were obtained in 78.7% of the interventions. Four treatment sessions reduced the VAS score by 10 mm in 83.55% of the sample. There were no statistically significant differences (P = .064) for reduction in pain intensity in the different body regions. Conclusions A multimodal rehabilitation protocol showed clinically relevant differences in the reduction in pain intensity in different body regions in patients with MPS.

      PubDate: 2017-08-02T14:19:04Z
      DOI: 10.1016/j.jmpt.2017.06.001
  • Response to Letter to Editor: “Best Practices for Chiropractic Care for
           Older Adults: A Consensus Update”
    • Authors: Brian Gleberzon; Cheryl Hawk; Paul Dougherty; Michael J. Schneider; Mitchell Haas; Lisa Z. Killinger; John Weeks
      Abstract: Publication date: Available online 21 July 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Brian Gleberzon, Cheryl Hawk, Paul Dougherty, Michael J. Schneider, Mitchell Haas, Lisa Z. Killinger, John Weeks

      PubDate: 2017-07-24T14:09:22Z
      DOI: 10.1016/j.jmpt.2017.06.002
  • The Effect of 2 Different Exercise Programs on Pain Intensity and Muscle
           Dimensions in Patients With Chronic Low Back Pain: A Randomized Controlled
    • Authors: Narjess Nabavi; Mohammad A. Mohseni Bandpei; Zahra Mosallanezhad; Mahdi Rahgozar; Shapour Jaberzadeh
      Abstract: Publication date: Available online 21 July 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Narjess Nabavi, Mohammad A. Mohseni Bandpei, Zahra Mosallanezhad, Mahdi Rahgozar, Shapour Jaberzadeh
      Objectives The purpose of this study was to compare the effect of 2 exercise programs combined with electrotherapy on pain intensity and lumbar stabilizer muscles dimensions in patients with nonspecific chronic low back pain. Methods A randomized controlled clinical trial was performed with 41 patients with chronic LBP. Participants were randomly allocated into 2 groups: an experimental group (n = 20) received stabilization exercises plus electrotherapy, and a control group (n = 21) received routine exercises plus electrotherapy. Pain intensity, using a visual analog scale, and muscle dimensions of both right and left transverse abdominis and lumbar multifidus muscles, using rehabilitative ultrasonography, were assessed before and immediately after 4 weeks of intervention. Results Significant improvement was identified after interventions on pain intensity and muscle size measurements in both groups (P < .01 in all instances). The only exception was the right-side lumbar multifidus cross-sectional area of the control group, which was not statistically significant (P = .081). No significant differences were found between the 2 exercise groups on pain intensity and muscle dimensions (P > .05 in all instances). Conclusions The results of this study suggest that a combination of electrotherapy with either routine or stabilization exercise programs may improve pain intensity and muscle dimensions in patients with nonspecific chronic low back pain.

      PubDate: 2017-07-24T14:09:22Z
      DOI: 10.1016/j.jmpt.2017.03.011
  • Prediction Effects of Personal, Psychosocial, and Occupational Risk
           Factors on Low Back Pain Severity Using Artificial Neural Networks
           Approach in Industrial Workers
    • Authors: Ebrahim Darvishi; Hassan Khotanlou; Jamshid Khoubi; Omid Giahi; Neda Mahdavi
      Abstract: Publication date: Available online 21 July 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ebrahim Darvishi, Hassan Khotanlou, Jamshid Khoubi, Omid Giahi, Neda Mahdavi
      Objectives This study aimed to provide an empirical model of predicting low back pain (LBP) by considering the occupational, personal, and psychological risk factor interactions in workers population employed in industrial units using an artificial neural networks approach. Methods A total of 92 workers with LBP as the case group and 68 healthy workers as a control group were selected in various industrial units with similar occupational conditions. The demographic information and personal, occupational, and psychosocial factors of the participants were collected via interview, related questionnaires, consultation with occupational medicine, and also the Rapid Entire Body Assessment worksheet and National Aeronautics and Space Administration Task Load Index software. Then, 16 risk factors for LBP were used as input variables to develop the prediction model. Networks with various multilayered structures were developed using MATLAB. Results The developed neural networks with 1 hidden layer and 26 neurons had the least error of classification in both training and testing phases. The mean of classification accuracy of the developed neural networks for the testing and training phase data were about 88% and 96%, respectively. In addition, the mean of classification accuracy of both training and testing data was 92%, indicating much better results compared with other methods. Conclusion It appears that the prediction model using the neural network approach is more accurate compared with other applied methods. Because occupational LBP is usually untreatable, the results of prediction may be suitable for developing preventive strategies and corrective interventions.

      PubDate: 2017-07-24T14:09:22Z
      DOI: 10.1016/j.jmpt.2017.03.012
  • Response to “Best Practices for Chiropractic Care for Older Adults: A
           Systematic Review and Consensus Update”
    • Authors: James M Cox
      Abstract: Publication date: Available online 21 July 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): James M Cox

      PubDate: 2017-07-24T14:09:22Z
      DOI: 10.1016/j.jmpt.2017.06.003
  • Thrust Magnitudes, Rates, and 3-Dimensional Directions Delivered in
           Simulated Lumbar Spine High-Velocity, Low-Amplitude Manipulation
    • Authors: Edward F. Owens; Ronald S. Hosek; Linda Mullin; Lydia Dever; Stephanie G.B. Sullivan; Brent S. Russell
      Abstract: Publication date: Available online 21 June 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Edward F. Owens, Ronald S. Hosek, Linda Mullin, Lydia Dever, Stephanie G.B. Sullivan, Brent S. Russell
      Objectives The purpose of this study was to measure faculty performance of simulated spinal manipulation on a mannequin to help identify teaching standards. Methods We measured 3-dimensional transmitted loads using a force plate mounted in the table. Thrusts were delivered through a compliant, jointed mannequin by faculty members along predefined “listings” as taught in lumbopelvic technique courses. Results Eleven chiropractic faculty members participated, delivering 9 thrusts at 3 loads (light, moderate, and heavy) along 9 different prone and side-posture listings, totaling 81 thrusts per participant. Single-hand Gonstead-style thrusts had variability in magnitude across participants and loads: light thrusts averaged 365 N (95% confidence interval [CI] 327-402), moderate thrusts 454 N (421-487), and heavy thrusts 682 N (623-740). All faculty members could easily distinguish the loads within their performances, but there was some crossover of load levels between participants. Thrust rates averaged 3.55 N/ms (95% CI 3.29-3.82). The dominant vector of prone thrusts was in the z direction (vertically downward), but side-to-side and inferior-to-superior vector components occurred. Conclusion Faculty member performance of simulated spinal manipulation indicated that they are able to control the thrust magnitude and rate as well as direction. In this sample, there was significant variability in peak loads between participants, which needs to be considered in student learning standards. These findings may be useful in translating the understanding of force characteristics to the technique teaching lab.

      PubDate: 2017-06-26T18:31:47Z
      DOI: 10.1016/j.jmpt.2017.05.002
  • Differences in Outcomes of Patients Treated by Male vs Female
    • Authors: Malin B. Muehlemann; Cynthia K. Peterson; B. Kim Humphreys
      Abstract: Publication date: Available online 21 June 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Malin B. Muehlemann, Cynthia K. Peterson, B. Kim Humphreys
      Objective The purpose of this study was to compare treatment outcomes of low back pain patients depending on the sex of the treating doctor of chiropractic (DC). Methods For this study, 1095 adult patients with no manual therapy in the prior 3 months were recruited. Pretreatment pain levels (Numeric Rating Scale for pain [NRS]), Oswestry Disability Index (ODI), and patient demographic details were recorded. The NRS and Patient Global Impression of Change were assessed after 1 week and 1, 3, 6, and 12 months. The ODI was completed up to 3 months. The χ2 test compared sex of the DC with the proportion of patients “improved” at all time points and with baseline categorical variables. The unpaired t test compared changes in NRS and ODI scores between patients of male and female DCs. Results Female DCs saw proportionally more acute patients (P = .012). Patients of male DCs presented more often with radiculopathy (P = .007). There were no differences in NRS and ODI baseline scores between male and female DCs’ patients. At 1 week and 3 and 12 months, significantly more patients of female DCs reported improvement and they had greater decreases in NRS and ODI scores at 1 week. Removing acute patients from the data, there were no longer differences in outcome. Conclusions Significant differences in treatment outcome in favor of female DCs was no longer present on removal of the acute subgroup from the data. This suggests that patient outcome is influenced by other factors, such as chronicity, rather than sex of the treating DC.

      PubDate: 2017-06-26T18:31:47Z
      DOI: 10.1016/j.jmpt.2017.05.001
  • Differences in Practice Characteristics Between Male and Female
           Chiropractors in Switzerland
    • Authors: Regina Vollenweider; Cynthia K. Peterson; B. Kim Humphreys
      Abstract: Publication date: Available online 17 June 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Regina Vollenweider, Cynthia K. Peterson, B. Kim Humphreys
      Objectives A total of 75% of the chiropractic medicine students in the new program at the University of Zürich are women, which is in stark contrast to the traditional ratio of chiropractors in Switzerland, where 75% have been men. Therefore, the purpose of this study was to compare work behaviors between female and male chiropractors relating to workload, patient variety, and chiropractic treatment techniques. Methods This is a secondary analysis of data from the Swiss Job Analysis 2009 study. The design was an online survey to all practicing chiropractors in Switzerland that had a 70% response rate of 183 returned surveys. Differences between male and female chiropractors in the various categorical responses involving practice workload, characteristics and patient types were compared using the χ2 test. Results Male chiropractors had significantly more years in practice (P = .0001), worked more hours per week (P = .0001), and saw more patients (P = .0001) and more new patients (P = .004) per week compared with female chiropractors. Female chiropractors spent significantly more time with patients during follow-up visits (P = .017). There were no significant differences in treatment techniques used or the types of patients seen between the sexes. Conclusion Because female chiropractors work fewer hours and see fewer patients per week, this may lead to a shortage of chiropractors in the future as the sex ratio within the profession slowly changes in Switzerland.

      PubDate: 2017-06-19T18:13:53Z
      DOI: 10.1016/j.jmpt.2017.03.004
  • Characteristics of Paraspinal Muscle Spindle Response to Mechanically
           Assisted Spinal Manipulation: A Preliminary Report
    • Authors: William R. Reed; Joel G. Pickar; Randall S. Sozio; Michael A.K. Liebschner; Joshua W. Little; Maruti R. Gudavalli
      Abstract: Publication date: Available online 17 June 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): William R. Reed, Joel G. Pickar, Randall S. Sozio, Michael A.K. Liebschner, Joshua W. Little, Maruti R. Gudavalli
      Objectives The purpose of this preliminary study is to determine muscle spindle response characteristics related to the use of 2 solenoid powered clinical mechanically assisted manipulation (MAM) devices. Methods L6 muscle spindle afferents with receptive fields in paraspinal muscles were isolated in 6 cats. Neural recordings were made during L7 MAM thrusts using the Activator V (Activator Methods Int. Ltd., Phoenix, AZ) and/or Pulstar (Sense Technology Inc., Pittsburgh, PA) devices at their 3 lowest force settings. Mechanically assisted manipulation response measures included (a) the time required post-thrust until the first action potential, (b) differences in mean frequency (MF) and mean instantaneous frequency (MIF) 2 seconds before and after MAM, and (c) the time required for muscle spindle discharge (MF and MIF) to return to 95% of baseline after MAM. Results Depending on device setting, between 44% to 80% (Pulstar) and 11% to 63% (Activator V) of spindle afferents required >6 seconds to return to within 95% of baseline MF values; whereas 66% to 89% (Pulstar) and 75% to 100% (Activator V) of spindle responses returned to within 95% of baseline MIF in <6 seconds after MAM. Nonparametric comparisons between the 22 N and 44 N settings of the Pulstar yielded significant differences for the time required to return to baseline MF and MIF. Conclusion Short duration (<10 ms) MAM thrusts decrease muscle spindle discharge with a majority of afferents requiring prolonged periods (>6 seconds) to return to baseline MF activity. Physiological consequences and clinical relevance of described MAM mechanoreceptor responses will require additional investigation.

      PubDate: 2017-06-19T18:13:53Z
      DOI: 10.1016/j.jmpt.2017.03.006
  • Information for Readers
    • Abstract: Publication date: June 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 5

      PubDate: 2017-06-19T18:13:53Z
  • Neck-Related Physical Function, Self-Efficacy, and Coping Strategies in
           Patients With Cervical Radiculopathy: A Randomized Clinical Trial of
           Postoperative Physiotherapy
    • Authors: Johanna Wibault; Birgitta Öberg; Åsa Dedering; Håkan Löfgren; Peter Zsigmond; Liselott Persson; Maria Andell; Margareta R. Jonsson; Anneli Peolsson
      Abstract: Publication date: Available online 9 May 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Johanna Wibault, Birgitta Öberg, Åsa Dedering, Håkan Löfgren, Peter Zsigmond, Liselott Persson, Maria Andell, Margareta R. Jonsson, Anneli Peolsson
      Objective The purpose of this study was to compare postoperative rehabilitation with structured physiotherapy to the standard approach in patients with cervical radiculopathy (CR) in a prospective randomized study at 6 months follow-up based on measures of neck-related physical function, self-efficacy, and coping strategies. Methods Patients with persistent CR and scheduled for surgery (N = 202) were randomly assigned to structured postoperative physiotherapy or a standard postoperative approach. Structured postoperative physiotherapy combined neck-specific exercises with a behavioral approach. Baseline, 3-month, and 6-month evaluations included questionnaires and clinical examinations. Neck muscle endurance, active cervical range of motion, self-efficacy, pain catastrophizing (CSQ-CAT), perceived control over pain, and ability to decrease pain were analyzed for between-group differences using complete case and per-protocol approaches. Results No between-group difference was reported at the 6-month follow-up (P = .05-.99), but all outcomes had improved from baseline (P < .001). Patients undergoing structured postoperative physiotherapy with ≥50% attendance at treatment sessions had larger improvements in CSQ-CAT (P = .04) during the rehabilitation period from 3 to 6 months after surgery compared with the patients who received standard postoperative approach. Conclusions No between-group difference was found at 6 months after surgery based on measures of neck-related physical function, self-efficacy, and coping strategies. However, the results confirm that neck-specific exercises are tolerated by patients with CR after surgery and may suggest a benefit from combining surgery with structured postoperative physiotherapy for patients with CR.

      PubDate: 2017-05-11T02:10:07Z
      DOI: 10.1016/j.jmpt.2017.02.012
  • Information for Readers
    • Abstract: Publication date: May 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 4

      PubDate: 2017-05-11T02:10:07Z
  • Association of Mild Leg Length Discrepancy and Degenerative Changes in the
           Hip Joint and Lumbar Spine
    • Authors: Kelvin J. Murray; Tom Molyneux; Michael R. Le Grande; Aurora Castro Mendez; Franz K. Fuss; Michael F. Azari
      Abstract: Publication date: Available online 18 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Kelvin J. Murray, Tom Molyneux, Michael R. Le Grande, Aurora Castro Mendez, Franz K. Fuss, Michael F. Azari
      Objective The purpose of this study was to evaluate the correlation between mild leg length discrepancy (LLD) and degenerative joint disease (DJD) or osteoarthritis. Methods We evaluated standard postural lumbopelvic radiographs from 255 adults (121 women and 134 men) who had presented with spinal pain for chiropractic care. Symmetry of femoral head diameters was used to exclude magnification errors. Pearson’s partial correlation was used to control for age and derive effect sizes for LLD on DJD in the hip and lower lumbar motion segments. Krippendorff’s α was used for intraobserver and interobserver reliability. Results A strong correlation was found between LLD and hip DJD in men (r = 0.532) and women (r = 0.246). We also found a strong correlation between LLD and DJD at the L5-S1 motion segment in men (r = 0.395) and women (r = 0.246). At the L4-5 spinal level this correlation was much attenuated in men (r = 0.229) and women (r = 0.166). Conclusions These findings suggest an association between LLD and hip and lumbar DJD. Cause–effect relationships between mild LLD and DJD deserve to be properly evaluated in future longitudinal cohort studies.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.03.001
  • Structure-Specific Movement Patterns in Patients With Chronic Low Back
           Dysfunction Using Lumbar Combined Movement Examination
    • Authors: Aubrey P. Monie; Roger I. Price; Christopher R.P. Lind; Kevin P. Singer
      Abstract: Publication date: Available online 14 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Aubrey P. Monie, Roger I. Price, Christopher R.P. Lind, Kevin P. Singer
      Objective A test-retest cohort study was conducted to assess the use of a novel computer-aided, combined movement examination (CME) to measure change in low back movement after pain management intervention in 17 cases of lumbar spondylosis. Additionally we desired to use a CME normal reference range (NRR) to compare and contrast movement patterns identified from 3 specific structural pathologic conditions: intervertebral disc, facet joint, and nerve root compression. Methods Computer-aided CME was used before and after intervention, in a cohort study design, to record lumbar range of movement along with pain, disability, and health self-report questionnaires in 17 participants who received image-guided facet, epidural, and/or rhizotomy intervention. In the majority of cases, CME was reassessed after injection together with 2 serial self-reports after an average of 2 and 14 weeks. A minimal clinically important difference of 30% was used to interpret meaningful change in self-reports. A CME NRR (n = 159) was used for comparison with the 17 cases. Post hoc observation included subgrouping cases into 3 discrete pathologic conditions, intervertebral disc, facet dysfunction, and nerve root compression, in order to report intergroup differences in CME movement. Results Seven of the 17 participants stated that a “combined” movement was their most painful CME direction. Self-report outcome data indicated that 4 participants experienced significant improvement in health survey, 5 improved by ≥30% on low back function, and 8 reported that low back pain was more bothersome than stiffness, 6 of whom achieved the minimal clinically important difference for self-reported pain. Subgrouping of cases into structure-specific groups provided insight to different CME movement patterns. Conclusion The use of CME assists in identifying atypical lumbar movement relative to an age and sex NRR. Data from this study, exemplified by representative case studies, provide preliminary evidence for distinct intervertebral disc, facet joint, and nerve root compression CME movement patterns in cases of chronic lumbar spondylosis.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.02.011
  • Trunk Muscle EMG During Intermediate Pilates Mat Exercises in Beginner
           Healthy and Chronic Low Back Pain Individuals
    • Authors: Ivye L.R. Pereira; Bergson Queiroz; Jefferson Loss; César Amorim; Isabel C.N. Sacco
      Abstract: Publication date: Available online 13 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ivye L.R. Pereira, Bergson Queiroz, Jefferson Loss, César Amorim, Isabel C.N. Sacco
      Objective The purpose of this study was to compare the electromyographic pattern of core muscles during intermediate Pilates mat exercises between healthy people and those with low back pain. Methods We evaluated healthy participants (n = 19; mean ± standard deviation [SD]: age 28 ± 8 years, body mass 65 ± 10 kg, height 160.0 ± 9.1 cm) and a low back pain group (n = 13; mean ± SD: age 30 ± 9 years, body mass 67 ± 12 kg, height 170.0 ± 6.6 cm). Electromyographic analysis assessed the multifidus, external oblique, internal oblique, and rectus abdominis muscles during classical Pilates exercises (single leg stretch, criss-cross, and dead bug). We calculated the root mean square normalized by maximum voluntary contraction, and the time of peak activation was provided by a linear envelope and normalized by the total movement cycle. Results The criss-cross exercise presented the highest values of root mean square for trunk flexors (rectus abdominis and oblique) compared with the other exercises, followed by the single leg stretch and the dead bug, which had similar muscle activation. The single leg stretch presented more activation of the rectus abdominis and oblique, whereas the criss-cross and dead bug created more activation of the oblique compared with the multifidus and rectus. Conclusions The Pilates exercises presented different muscle recruitment patterns, and allowed the activation of the lumbopelvic stabilizing muscles even in the first session for healthy individuals and those with chronic low back pain.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.02.010
  • Cadaveric and Ultrasonographic Validation of Needling Placement in the
           Cervical Multifidus Muscle
    • Authors: César Fernández-de-las-Peñas; Juan A. Mesa-Jiménez; Jose A. Paredes-Mancilla; Shane L. Koppenhaver; Samuel Fernández-Carnero
      Abstract: Publication date: Available online 13 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): César Fernández-de-las-Peñas, Juan A. Mesa-Jiménez, Jose A. Paredes-Mancilla, Shane L. Koppenhaver, Samuel Fernández-Carnero
      Objective The aim of this study was to determine if a needle is able to reach the cervical multifidus during the application of dry needling or acupuncture. Methods Dry needling and ultrasound imaging of cervical multifidi was conducted on 5 patients (age: 32 ± 5 years) with mechanical neck pain and on 2 fresh cadavers (age: 64 ± 1 years). Dry needling was done using a needle of 40 mm in length inserted perpendicular to the skin about 1 cm lateral to the spinous process at C3-C4. The needle was advanced from a posterior to anterior direction into the cervical multifidus with a slight inferior-medial angle (approximately 10°) to reach the vertebra lamina. For the cadaveric study, the multifidus was isolated by carefully resecting the superficial posterior cervical muscles: trapezius, splenius, and semispinalis. For the ultrasonographic study, a convex transducer was placed transversely over C3-C4 after the insertion of the needle into the muscle. Results The results of both the cadaveric and ultrasonic studies found that the needle does pierce the cervical multifidus muscle during insertion and that the tip of the needle rests properly against the vertebral laminae, thereby guarding the sensitive underlying spinal structures from damage. Conclusion This anatomical and ultrasound imaging study supports that dry needling of the cervical multifidus could be conducted clinically.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.03.002
  • Ultrasound Assessment of Abdominal Muscle Thickness in Women With and
           Without Low Back Pain During Pregnancy
    • Authors: Carol Ann Weis; Jennifer Nash; John J. Triano; Jon Barrett
      Abstract: Publication date: Available online 12 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Carol Ann Weis, Jennifer Nash, John J. Triano, Jon Barrett
      Objective The aim of this preliminary study was to determine the differences in abdominal musculature thickness, within 1 month of delivery, in women who experienced back pain during pregnancy compared with those who did not. Methods B-mode ultrasound imaging was used to measure abdominal muscle thickness on 76 postpartum participants who participated in a larger study; 47 women experienced back pain during pregnancy, and 29 did not. Participant data were stratified by group, and primary comparisons were based on these grouping across the abdominal muscles, including rectus abdominis (upper and lower fibers), external oblique, internal oblique, and transversus abdominis. Means and standard deviations were also used to set parameters for future studies. Results In the present study, there was no difference in any abdominal muscle thickness between groups. Women with low back pain were significantly shorter (165.19 ± 6.64 cm) than women who did not have from back pain during pregnancy (169.38 ± 7.58 cm). All other demographics, such as age, weight, and date tested postpartum, were not significantly different between groups. Conclusion The results of this study showed no variation in abdominal muscle thickness in women who had back pain during pregnancy and those who did not.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.02.002
  • Correlation Between Upper Limb Volume and Arterial and Venous Blood Flow
           Velocity in Lymphedema Secondary to Breast Cancer Treatment
    • Authors: Monique Silva Rezende; Ana Luiza Marsengo; Amanda Apolinário; Vânia Tie Koga Ferreira; Elaine Caldeira de Oliveira Guirro
      Abstract: Publication date: Available online 12 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Monique Silva Rezende, Ana Luiza Marsengo, Amanda Apolinário, Vânia Tie Koga Ferreira, Elaine Caldeira de Oliveira Guirro
      Objective The purpose of this study was to correlate upper limb volume and arterial and venous blood flow velocity in breast cancer survivors. Methods A cross-sectional study was conducted on 30 women with lymphedema and a mean age of 55.60 years (standard deviation = 8.12). For the assessment of upper limb volume, perimetry was performed with measures at 6 points on the limb, which were mathematically calculated as volume. The blood flow velocity of the axillary and brachial arteries and veins were assessed by Doppler ultrasound with a probe at 4 MHz. In the statistical analysis, a Shapiro-Wilk test determined a non-normal data distribution. Spearman correlation coefficients (ρ) were calculated to determine the association between the variables blood flow velocity and lymphedema volume. Results We identified significant and positive associations between all variables correlated with limb volume: blood flow velocity of the axillary artery (ρ = 0.381, P = .041), axillary vein (ρ = 0.383, P = .039), brachial artery (ρ = 0.375, P = .044), and the brachial vein (ρ = 0.373, P = .045). Conclusion There is a positive association between limb volume and blood flow velocity in the upper limbs of women with lymphedema secondary to breast cancer treatment.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.02.008
  • Efficacy of Manual Therapy Including Neurodynamic Techniques for the
           Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial
    • Authors: Tomasz Wolny; Edward Saulicz; Paweł Linek; Michael Shacklock; Andrzej Myśliwiec
      Abstract: Publication date: Available online 8 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Tomasz Wolny, Edward Saulicz, Paweł Linek, Michael Shacklock, Andrzej Myśliwiec
      Objective The purpose of this randomized trial was to compare the efficacy of manual therapy, including the use of neurodynamic techniques, with electrophysical modalities on patients with mild and moderate carpal tunnel syndrome (CTS). Methods The study included 140 CTS patients who were randomly assigned to the manual therapy (MT) group, which included the use of neurodynamic techniques, functional massage, and carpal bone mobilizations techniques, or to the electrophysical modalities (EM) group, which included laser and ultrasound therapy. Nerve conduction, pain severity, symptom severity, and functional status measured by the Boston Carpal Tunnel Questionnaire were assessed before and after treatment. Therapy was conducted twice weekly and both groups received 20 therapy sessions. Results A baseline assessment revealed group differences in sensory conduction of the median nerve (P < .01) but not in motor conduction (P = .82). Four weeks after the last treatment procedure, nerve conduction was examined again. In the MT group, median nerve sensory conduction velocity increased by 34% and motor conduction velocity by 6% (in both cases, P < .01). There was no change in median nerve sensory and motor conduction velocities in the EM. Distal motor latency was decreased (P < .01) in both groups. A baseline assessment revealed no group differences in pain severity, symptom severity, or functional status. Immediately after therapy, analysis of variance revealed group differences in pain severity (P < .01), with a reduction in pain in both groups (MT: 290%, P < .01; EM: 47%, P < .01). There were group differences in symptom severity (P < .01) and function (P < .01) on the Boston Carpal Tunnel Questionnaire. Both groups had an improvement in functional status (MT: 47%, P < .01; EM: 9%, P < .01) and a reduction in subjective CTS symptoms (MT: 67%, P < .01; EM: 15%, P < .01). Conclusion Both therapies had a positive effect on nerve conduction, pain reduction, functional status, and subjective symptoms in individuals with CTS. However, the results regarding pain reduction, subjective symptoms, and functional status were better in the MT group.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.02.004
  • Effects of Holding an External Load on the Standing Balance of Older and
           Younger Adults With and Without Chronic Low Back Pain
    • Authors: Leonardo Shigaki; Edgar Ramos Vieira; André Wilson de Oliveira Gil; Cynthia Gobbi Alves Araújo; Mariana Zingari Carmargo; Leandro Amaral Sturion; Marcio Roǵerio de Oliveira; Rubens A. da Silva
      Abstract: Publication date: Available online 8 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Leonardo Shigaki, Edgar Ramos Vieira, André Wilson de Oliveira Gil, Cynthia Gobbi Alves Araújo, Mariana Zingari Carmargo, Leandro Amaral Sturion, Marcio Roǵerio de Oliveira, Rubens A. da Silva
      Objective The purpose of this study was to assess the effect of holding an external load on the standing balance of younger and older adults with and without chronic low back pain (CLBP). Methods Twenty participants with and 20 without CLBP participated in the study. Each group contained 10 younger (50% men) and 10 older adults (50% men). Participants were instructed to look straight ahead while standing on a force platform during two 120-second trials with and without holding an external load (10% of body mass). The center of pressure area, mean velocity, and mean frequency in the anteroposterior and mediolateral directions were measured. Results Older adults had worse standing balance than younger adults did (P < .001, d = 0.20). There were no significant balance differences between participants with and without CLBP within age groups during standing balance condition. However, holding the external load significantly increased postural instability for both age groups and CLBP status, with mean effect size across center of pressure variables of d = 0.82 for older participants without CLBP and d = 2.65 for younger participants without CLBP. These effects for people with CLBP were d = 1.65 for subgroup of older and d = 1.60 for subgroup of younger participants. Conclusion Holding an external load of 10% of body mass increased postural instability of both younger and older adults with and without CLBP.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.01.007
  • Manual Lymphatic Drainage in Blood Circulation of Upper Limb With
           Lymphedema After Breast Cancer Surgery
    • Authors: Raquel Michelini Guerero; Lais Mara Siqueira das Neves; Rinaldo Roberto de Jesus Guirro; Elaine Caldeira de Oliveira Guirro
      Abstract: Publication date: Available online 8 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Raquel Michelini Guerero, Lais Mara Siqueira das Neves, Rinaldo Roberto de Jesus Guirro, Elaine Caldeira de Oliveira Guirro
      Objective The purpose of this study was to assess blood flow after manual lymphatic drainage (MLD) in women who had received surgery for breast cancer and had post–axillary lymphadenectomy lymphedema. Methods Sixteen volunteers (mean age 64 ± 11.44 years) were divided into 2 groups. Those in group 1 received MLD without upper limb elevation, and those in group 2 received MLD with elevation of 30° of the upper limb. Blood flow velocity of the brachial vein and artery were measured using Doppler ultrasound before, immediately after, and 30 minutes after MLD, with and without 30° of upper limb elevation as defined by a random crossover design and an interval (washout) of 7 days. Comparison of data before and after MLD was evaluated by the Friedman test. Results There was a significant increase of blood flow velocity in the brachial vein after the therapeutic procedure with upper limb elevation. However, after 30 minutes the data returned to the pretreatment value. Conclusion This preliminary study indicated that MLD promoted increased brachial vein velocity flow in the short term.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.02.009
  • Intra- and Inter-rater Reliability of Peripheral Arterial Blood Flow
           Velocity by Means of Doppler Ultrasound
    • Authors: Elaine Caldeira de Oliveira Guirro; Gabriella de Paula Marcondes Ferreira Leite; Almir Vieira Dibai-Filho; Nathalia Cristina de Souza Borges; Rinaldo Roberto de Jesus Guirro
      Abstract: Publication date: Available online 6 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Elaine Caldeira de Oliveira Guirro, Gabriella de Paula Marcondes Ferreira Leite, Almir Vieira Dibai-Filho, Nathalia Cristina de Souza Borges, Rinaldo Roberto de Jesus Guirro
      Objective Although it is possible to find studies that analyze the velocity of blood flow in different arteries, the reliability of Doppler ultrasound on peripheral arteries has not yet been completely established. Our objective was to evaluate intra- and inter-rater reliability of the measurement of blood flow velocity by Doppler ultrasound of brachial, radial, popliteal, and posterior tibial arteries. Methods Fifty healthy individuals of both genders, aged between 18 and 45 years, were included in the study. For the evaluation of arterial blood flow velocity, a portable Doppler ultrasound device was used to measure the mean and maximum blood flow velocity of posterior tibial, popliteal, brachial, and radial arteries. Two examiners performed assessments of the same volunteers independently and twice, with an interval of 1 week between them. Results We found good to very good reliability for measuring the mean and maximum blood flow velocity of the arteries evaluated. The intraclass correlation coefficients ranged between 0.501 and 0.866, standard error of measurement ranged between 0.81 and 9.45 cm/s, and minimum detectable change ranged between 2.25 and 26.13 cm/s. Conclusion The assessment of mean and maximum blood flow velocity of the brachial, radial, popliteal, and posterior tibial arteries by means of Doppler ultrasound presents acceptable reliability values, which supports the use of this evaluation method in research and clinical practice.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.02.007
  • Association Between Severity of Temporomandibular Disorders and the
           Frequency of Headache Attacks in Women With Migraine: A Cross-Sectional
    • Authors: Lidiane Lima Florencio; Anamaria Siriani de Oliveira; Gabriela Ferreira Carvalho; Fabiola Dach; Marcelo Eduardo Bigal; César Fernández-de-las-Peñas; Débora Bevilaqua-Grossi
      Abstract: Publication date: Available online 6 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Lidiane Lima Florencio, Anamaria Siriani de Oliveira, Gabriela Ferreira Carvalho, Fabiola Dach, Marcelo Eduardo Bigal, César Fernández-de-las-Peñas, Débora Bevilaqua-Grossi
      Objective The aim of this study was to investigate the magnitude of association of the severity of temporomandibular disorders (TMDs) in women with episodic and chronic migraine. Methods Thirty-one women with episodic migraine (mean age: 33 years), 21 with chronic migraine (mean age: 35 years) and 32 healthy controls (mean age: 31 years) were included. The Fonseca Anamnestic Index was applied to assess severity of TMDs. TMD severity was considered as follows: no TMD (0-19 points), mild TMD (20-49 points), moderate TMD (50-69 points), and severe TMD (70-100 points). To compare the proportion of TMD severity among groups, a χ2 test was performed. Prevalence ratio (PR) was calculated to determine the association of TMD severity and both migraine groups using the control group as the reference. Results Women with chronic and episodic migraine were more likely to exhibit TMD signs and symptoms of any severity than healthy controls (χ2 = 30.26; P < .001). TMD prevalence was 54% for healthy controls, 78% for episodic migraine, and 100% for chronic migraine. Women with chronic migraine exhibited greater risk of more severe manifestations of TMD than healthy controls (PR: 3.31; P = .008). This association was not identified for episodic migraine (PR: 2.18; P = .101). Conclusion The presence of TMD signs and symptoms was associated with migraine independently of the frequency; however, the magnitude of the association of more severe TMD was significantly greater in chronic, but not episodic, migraine.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.02.006
  • Test-Retest Reliability of Measuring the Vertebral Arterial Blood Flow
           Velocity in People With Cervicogenic Dizziness
    • Authors: Gary L. Shum; Sally Cinnamond; Alan D. Hough; Richard Craven; Wayne Whittingham
      Abstract: Publication date: Available online 6 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Gary L. Shum, Sally Cinnamond, Alan D. Hough, Richard Craven, Wayne Whittingham
      Objectives The purpose of this study was to determine the within-session and between-sessions reliability of measuring the vertebral artery blood flow velocities in people with cervicogenic dizziness using Doppler ultrasound at both upper and lower cervical levels. Methods Outcome measures were taken on 2 occasions 3 weeks apart with no active treatment provided in between the assessments on 12 participants. Pulsed-wave Doppler ultrasound was used to quantify time-averaged mean velocities through the vertebral artery at upper cervical (C0-1) and lower cervical vertebrae (C5-6). The clinical outcome measures were also recorded in people with cervicogenic dizziness. The intraclass correlation coefficient (ICC) was used to determine the within-session and between-session repeatability. Paired t test was used to determine the differences in the time-averaged mean velocities of blood flow at the same site of the vertebral artery and the clinical outcome measures in 2 sessions 3 weeks apart. Results In people with cervicogenic dizziness, there was no significant change in both clinical outcome measures and the time-averaged mean velocities when the patients were measured 3 weeks apart (P > .05). This study identified good within-session (ICC: 0.903-0.967) and between-session (ICC: 0.922-0.984) repeatability in measuring the vertical blood flow velocities in patients with cervicogenic dizziness when the clinical outcome measures were unchanged. Conclusions This study supports the use of Doppler ultrasound to identify changes in mean vertebral arterial blood flow velocities before and after intervention in people with cervicogenic dizziness in future studies.

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.02.005
  • Effects of Anteroposterior Talus Mobilization on Range of Motion, Pain,
           and Functional Capacity in Participants With Subacute and Chronic Ankle
           Injuries: A Controlled Trial
    • Authors: Rafael Duarte Silva; Luciana Mundim Teixeira; Tarcísio Santos Moreira; Luci Fuscaldi Teixeira-Salmela; Marcos Antônio de Resende
      Abstract: Publication date: Available online 6 April 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Rafael Duarte Silva, Luciana Mundim Teixeira, Tarcísio Santos Moreira, Luci Fuscaldi Teixeira-Salmela, Marcos Antônio de Resende

      PubDate: 2017-05-06T01:48:01Z
      DOI: 10.1016/j.jmpt.2017.02.003
  • Information for Readers
    • Abstract: Publication date: March–April 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 3

      PubDate: 2017-05-06T01:48:01Z
  • Manipulation Peak Forces Across Spinal Regions for Children Using
           Mannequin Simulators
    • Authors: John J. Triano; Steven Lester; David Starmer; Elise G. Hewitt
      Abstract: Publication date: Available online 6 March 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): John J. Triano, Steven Lester, David Starmer, Elise G. Hewitt
      Objective The purpose of this work was to create an exploratory database of manipulation treatment force variability as a function of the intent of an experienced clinician sub-specializing in the care of children to match treatment to childhood category. Data of this type are necessary for realistic planning of dose–response and safety studies on therapeutic benefit. Methods The project evaluated the transmitted peak forces of procedures applied to mannequins of different stature for younger and older children. Common procedures for the cervical, thoracic, and lumbar spine and sacroiliac joint were administered to estimate variability by a single experienced practitioner and educator in pediatric manipulation attempting to modulate for childhood category. Results described for peak components in the cardinal axes and for peak total forces were cataloged and compared with consensus estimates of force from the literature. Results Mean force values for both components and total force peaks monotonically increased with childhood category analogous to consensus expectations. However, a mismatch was observed between peak values measured and consensus predictions that ranged by a factor of 2 to 3.5, particularly in the upper categories. Quantitative data permit a first estimate of effect size for future clinical studies. Conclusions The findings of this study indicate that recalibration of spinal manipulation performance of experienced clinicians toward arbitrary target values similar to consensus estimates is feasible. What is unclear from the literature or these results is the identity of legitimate target values that are both safe and clinically effective based on childhood categories in actual practice.

      PubDate: 2017-03-12T02:33:57Z
      DOI: 10.1016/j.jmpt.2017.01.001
  • Effects of Diaphragmatic Breathing Patterns on Balance: A Preliminary
           Clinical Trial
    • Authors: Rylee J. Stephens; Mitchell Haas; William L. Moore; Jordan R. Emmil; Jayson A. Sipress; Alex Williams
      Abstract: Publication date: Available online 1 March 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Rylee J. Stephens, Mitchell Haas, William L. Moore, Jordan R. Emmil, Jayson A. Sipress, Alex Williams
      Objective The purpose of this study was to determine the feasibility of performing a larger study to determine if training in diaphragmatic breathing influences static and dynamic balance. Methods A group of 13 healthy persons (8 men, 5 women), who were staff, faculty, or students at the University of Western States participated in an 8-week breathing and balance study using an uncontrolled clinical trial design. Participants were given a series of breathing exercises to perform weekly in the clinic and at home. Balance and breathing were assessed at the weekly clinic sessions. Breathing was evaluated with Liebenson’s breathing assessment, static balance with the Modified Balance Error Scoring System, and dynamic balance with OptoGait’s March in Place protocol. Results Improvement was noted in mean diaphragmatic breathing scores (1.3 to 2.6, P < .001), number of single-leg stance balance errors (7.1 to 3.8, P = .001), and tandem stance balance errors (3.2 to 0.9, P = .039). A decreasing error rate in single-leg stance was associated with improvement in breathing score within participants over the 8 weeks of the study (–1.4 errors/unit breathing score change, P < .001). Tandem stance performance did not reach statistical significance (–0.5 error/unit change, P = .118). Dynamic balance was insensitive to balance change, being error free for all participants throughout the study. Conclusion This proof-of-concept study indicated that promotion of a costal-diaphragmatic breathing pattern may be associated with improvement in balance and suggests that a study of this phenomenon using an experimental design is feasible.

      PubDate: 2017-03-07T02:16:32Z
      DOI: 10.1016/j.jmpt.2017.01.005
  • Cross-Cultural Adaptation of the Profile Fitness Mapping Neck
           Questionnaire to Brazilian Portuguese: Internal Consistency, Reliability,
           and Construct and Structural Validity
    • Authors: Mariana Cândido Ferreira; Martin Björklund; Fabiola Dach; Thais Cristina Chaves
      Abstract: Publication date: Available online 1 March 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Mariana Cândido Ferreira, Martin Björklund, Fabiola Dach, Thais Cristina Chaves
      Objective The purpose of this study was to adapt and evaluate the psychometric properties of the ProFitMap-neck to Brazilian Portuguese. Methods The cross-cultural adaptation consisted of 5 stages, and 180 female patients with chronic neck pain participated in the study. A subsample (n = 30) answered the pretest, and another subsample (n = 100) answered the questionnaire a second time. Internal consistency, test-retest reliability, and construct validity (hypothesis testing and structural validity) were estimated. For construct validity, the scores of the questionnaire were correlated with the Neck Disability Index (NDI), and the Hospital Anxiety and Depression Scale (HADS), the Tampa Scale of Kinesiophobia (TSK), and the 36-item Short-Form Health Survey (SF-36). Results Internal consistency was determined by adequate Cronbach's α values (α > 0.70). Strong reliability was identified by high intraclass correlation coefficients (ICC > 0.75). Construct validity was identified by moderate and strong correlations of the Br-ProFitMap-neck with total NDI score (–0.56 < R < –0.71) and with the SF-36, HADS-anxiety, HADS-depression, and TSK (–0.32 < R < –0.82). Exploratory factor analysis revealed 2 factors for the Symptom scale: intensity index and the Function scale. Symptom scale–frequency index identified 1 factor. Structural validity was determined by percentage of cumulative variance >50%, Kaiser-Meyer-Olkin index > 0.50, eigenvalue > 1, and factor loadings > 0.2. Conclusion Br-ProFitMap-neck had adequate psychometric properties and can be used in clinical settings, as well as research, in patients with chronic neck pain.

      PubDate: 2017-03-07T02:16:32Z
      DOI: 10.1016/j.jmpt.2017.01.004
  • Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual
           Somatosensory Input in Chronic Pain Patients: A Preliminary Study
    • Authors: Heidi Haavik; Imran Khan Niazi; Kelly Holt; Bernadette Murphy
      Abstract: Publication date: Available online 10 February 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Heidi Haavik, Imran Khan Niazi, Kelly Holt, Bernadette Murphy
      Objective The purpose of this preliminary study was to assess whether the dual somatosensory evoked potential (SEP) technique is sensitive enough to measure changes in cortical intrinsic inhibitory interactions in patients with chronic neck or upper extremity pain and, if so, whether changes are associated with changes in pain scores. Methods The dual peripheral nerve stimulation SEP ratio technique was used for 6 subjects with a history of chronic neck or upper limb pain. SEPs were recorded after left or right median and ulnar nerve stimulation at the wrist. SEP ratios were calculated for the N9, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median and ulnar nerves. Outcome measures of SEP ratios and subjects’ visual analog scale rating of pains were recorded at baseline, after a 2-week usual care control period, and after 12 weeks of multimodal chiropractic care (chiropractic spinal manipulation and 1 or more of the following: exercises, peripheral joint adjustments/manipulation, soft tissue therapy, and pain education). Results A significant decrease in the median and ulnar to median plus ulnar ratio and the median and ulnar amplitude for the cortical P22-N30 SEP component was observed after 12 weeks of chiropractic care, with no changes after the control period. There was a significant decrease in visual analog scale scores (both for current pain and for pain last week). Conclusion The dual SEP ratio technique appears to be sensitive enough to measure changes in cortical intrinsic inhibitory interactions in patients with chronic neck pain. The observations in 6 subjects revealed that 12 weeks of chiropractic care improved suppression of SEPs evoked by dual upper limb nerve stimulation at the level of the motor cortex, premotor areas, and/or subcortical areas such as basal ganglia and/or thalamus. It is possible that these findings explain one of the mechanisms by which chiropractic care improves function and reduces pain for chronic pain patients.

      PubDate: 2017-02-13T16:25:50Z
      DOI: 10.1016/j.jmpt.2016.10.002
  • Procedure Selection and Patient Positioning Influence Spine Kinematics
           During High-Velocity, Low-Amplitude Spinal Manipulation Applied to the Low
    • Authors: Spencer Bell; Kevin D’Angelo; Gregory N. Kawchuk; John J. Triano; Samuel J. Howarth
      Abstract: Publication date: Available online 10 February 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Spencer Bell, Kevin D’Angelo, Gregory N. Kawchuk, John J. Triano, Samuel J. Howarth
      Objectives This investigation compared indirect 3-dimensional angular kinematics (position, velocity, and acceleration) of the lumbar spine for 2 different high-velocity, low-amplitude (HVLA) spinal manipulation procedures (lumbar spinous pull or push), and altered initial patient lower limb posture. Methods Twenty-four participants underwent 6 HVLA procedures directed toward the presumed L4 vertebra, reflecting each combination of 2 variants of a spinal manipulation application technique (spinous pull and push) and 3 initial hip flexion angles (0°, 45°, and 90°) applied using a right lateral recumbent patient position. All contact forces and moments between the patient and the external environment, as well as 3-dimensional kinematics of the patient’s pelvis and thorax, were recorded. Lumbar spine angular positions, velocities, and accelerations were analyzed within the preload and impulse stages of each HVLA trial. Results Lumbar spine left axial rotation was greater for the pull HVLA. The pull HVLA also generated a greater maximum (leftward) and lower minimum (rightward) axial rotation velocity and deceleration and greater leftward and rightward lateral bend velocities, acceleration, and deceleration components. Not flexing the hip produced the greatest amount of extension, as well as the lowest axial rotation and maximum axial rotation acceleration during the impulse. Conclusions This investigation provides basic kinematic information for clinicians to understand the similarities and differences between 2 HVLA side-lying manipulations in the lumbar spine. Use of these findings and novel technology can drive future research initiatives that can both affect clinical decision making and influence teaching environments surrounding spinal manipulative therapy skill acquisition.

      PubDate: 2017-02-13T16:25:50Z
      DOI: 10.1016/j.jmpt.2016.10.014
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