Cervical Dysfunction Research Articles

Osteopathic Manipulative Treatment and Breastfeeding

ObjectiveOsteopathic physicians, or doctors of osteopathic medicine (DOs), routinely counsel patients on the clinical benefits of breastfeeding in their capacity as medical doctors. However, when a mother presents with a complaint of feeding difficulty in her newborn, osteopathic physicians are uniquely equipped to assess and treat the infant with osteopathic manipulative treatment (OMT).MethodsOMT is the practice of manual medicine developed by A.T. Still in the late 19th century, founded on the principle that the human body's structure and function are reciprocally interrelated. The osteopathic discipline encompasses a variety of musculoskeletal techniques, ranging from gentle myofascial release to high-velocity/low-amplitude thrusts. A complete osteopathic assessment of a breastfeeding infant should include evaluation of the skull and cranial base, cervical spine, thoracic spine, oral cavity and tongue, hyoid bone, and mandible.ResultsAll treatments directed at newborns, infants, and children are very gentle, following the tissues in their position of ease to allow for a release of the restriction. A variety of techniques can be employed, including condylar decompression, Still technique for cervical spine dysfunction, balancing of the hyoid bone, myofascial release of the thoracic inlet, and treatments in the cranial field.ConclusionOsteopathic manipulation should be initiated when the first-line interventions do not result in improved nursing, and other causes such as hypoglycemia or maternal factors have been excluded.

Factors associated with cervical arterial dysfunction: a survey of physical therapist educators in the United States

ABSTRACT Objectives: The purpose of this study was to identify the key constructs associated with symptom description and behavior, natural history of complaints, and previous medical history of cervical arterial dysfunction (CAD) according to a panel of physical therapist (PT) educators. Methods: An electronic survey was conducted of licensed PT educators currently involved in musculoskeletal physical therapy education within a credentialed program. Survey prompts queried educators to list the subjective and objective items associated with CAD, in open-text format. Responses were coded to identify unique themes (constructs). Principal axis factor analysis with Varimax rotation was performed to identify underlying constructs associated with CAD according to the panel of educators. Results: Seventy-two educators completed the survey (24.2% response rate) resulting in 50 identified unique items through thematic coding. Factor analysis (Kaiser-Meyer-Olkin measure of sampling adequacy = .679, Bartlett’s test of sphericity (x 2(351) = 1129.06. p < .001), resulted in a four-factor solution: ‘5Ds and 3 Ns,’ ‘Other Neurological Findings,’ ‘Signs & Symptoms in Rotation and/or Extension,’ and ‘General Health.’ Discussion: According to the PT educators in this study, the factors associated with CAD appear to reflect the IFOMPT guidelines. The responses and subsequent factor analysis demonstrate the lack of any one clinical finding for the identification of CAD in a patient with neck pain. Level of Evidence: V.

Proposing a new algorithm for premanipulative testing in physical therapy practice.

In the field of physical therapy, there is debate as to the clinical utility of premanipulative vascular assessments. Cervical artery dysfunction (CAD) risk assessment involves a multi-system approach to differentiate between spontaneous versus mechanical events. The purposes of this inductive analysis of the literature are to discuss the link between cervical spine manipulation (CSM) and CAD, to examine the literature on premanipulative vascular tests, and to suggest an optimal sequence of premanipulative testing based on the differentiation of a spontaneous versus mechanical vascular event. Knowing what premanipulative vascular tests assess and the associated clinical application facilitates an evidence-informed decision for clinical application of vascular assessment before CSM.

Age-related white matter hyperintensities: a contribution of cervical venous dysfunction

Age-related white matter hyperintensities: a contribution of cervical venous dysfunction

Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial

To compare the effects of eccentric muscle energy technique versus static stretching exercises combined with cervical segmental mobilisation in the management of upper cross syndrome in patients having neck pain. The randomised controlled trial was conducted at the Khan Kinetic Treatment Canada Orthopaedic and Rehabilitation Centre, Rawalpindi, Pakistan, from August 2017 to January 2018, and comprised patients of upper cross syndrome who were randomized into two equal groups using lottery method. Patients in Group-A were treated with eccentric muscle energy technique with cervical segmental mobilisation, while those in Group-B received static stretching exercises with cervical segmental mobilisation. Two sessions per week for 3 weeks were given to each patient who were analysed by measuring tragus-to-wall distance, visual analogue scale and neck disability index. Cervical passive range of motion was measured using inclinometer. Data was recorded at baseline and after 3 weeks of treatment. Data was analysed using SPSS 21. Of the 40 subjects, 20(50%) each were in the two groups. In Group-A mean age was 42.75±11.13 years. In Group-B, it was 40.50±9.14 years. Eccentric muscle energy technique and static stretching technique both showed significant results (p<0.05) for within group analysis, but comparison across groups showed non-significant results (p>0.05 each) on all parameters. Both the techniques used were found to be equally effective in decreasing pain, improving cervical range of motion and reducing neck disability.

Comparative Immediate Effects of Isometric Chin-tuck and Dynamic Neuromuscular Stabilization on Neck Flexor Muscle Thickness and Upright Sitting Height Posture

Background: Cervical dysfunction is a common pathomechanical marker in individuals with forward head posture (FHP). To overcome the limitations of the isometric chin-tuck (ICT) exercise, dynamic neuromuscular stabilization (DNS), which emphasizes an entire spinal chain exercise, has recently shown promising clinical results.Objects: Purpose of this study was to compare the immediate effects between ICT and DNS techniques. Methods: 43 young subjects (mean age, 24.0±5.0 years) were recruited. Group of subjects with FHP were measured under baseline, ICT, and DNS conditions. Outcome measures included sitting height, longus colli (LC) and sternocleidomastoid (SCM) muscle thickness and LC/SCM thickness ratio. One-way repeated measures ANOVA was used to compare the continuous dependent variables among FHP, ICT, and DNS conditions at p<.016. Results: Both ICT and DNS exercise conditions yielded significantly increased LC muscle thickness,LC/SCM thickness ratio and sitting height than did FHP condition (p<.0001, respectively). Sitting height was significantly greater in DNS exercise than in the ICT exercise (p<.0001).Conclusion: The present results demonstrated that sitting height was greater in the DNS exercise than in the ICT exercise, as well as both corrective postural training exercises were effective on LC/SCM muscle balance ratio when compared with the baseline FHP condition. Therefore, it is considered that DNS exercise can be the recommended exercise for people with FHP.

Assessment of the occurrence of pain in the cervical spine and knowledge of physiotherapy and computer science students about Text Neck Syndrome

&lt;b&gt;Aim.&lt;/b&gt; The aim of the study was to assess the frequency of cervical spine pain and students' knowledge about Text Neck Syndrome. &lt;b&gt;Material and research methodology.&lt;/b&gt; The study covered 150 students of Physiotherapy and Computer Science, aged 18 - 26. The study used questionnaire consisting of 24 questions, as well as the NDI (Neck Disability Index) questionnaire. &lt;b&gt;Results.&lt;/b&gt; The research have shown, that 69% of respondents have experienced cervical spine pain in their lives. Almost half of the students have heard about Text Neck Syndrome. A relationship between the frequency of neck pain and the age at which neck pain appeared for the first time, physical activity, the number of hours spent using the cell phone and the position taken while using the phone as well as the position taken at work were demonstrated . The relationship between the sum of points obtained in the NDI questionnaire and the number of hours allocated to using a mobile phone was also demonstrated. &lt;b&gt;Conclusions.&lt;/b&gt; Most students have experienced cervical spine pain in their lives. Many factors affect the incidence of neck pain. Almost half of the respondents heard about Text Neck Syndrome. The use of cell phones affects the pain and level of cervical spine dysfunction.

Isometric osteopathic manipulation influences on cervical ranges of motion and correlation with osteopathic palpatory diagnosis: A randomized trial

IntroductionIsometric manipulation is a current practice in osteopathy and treatment benefits have been reported in the literature. Such benefits could be assessed using experimental non-invasive cervical mobility measurements. The main objective was to quantitatively measure the effects of isometric manipulation on principal and compensatory cervical motions. Methods101 healthy volunteers were included in this study. 51 healthy volunteers selected randomly underwent the experimental protocol before and after isometric treatment and were compared to 50 healthy volunteers who underwent a placebo treatment. Osteopathic diagnosis was performed on each healthy volunteer before and after the treatment. The experimental protocol included measurements by a motion capture system focusing on principal range of motion and compensatory motions. ResultsIn both the isometric and the placebo sample, respectively including 51 (age: 29.2 ± 8.1, BMI: 22.2 ± 3.5) and 50 healthy volunteers (age: 27.4 ± 6.8, BMI: 22.9 ± 2.8), a pre-treatment diagnosis revealed a light cervical dysfunction in all subjects, mainly in levels C3 and C4. Altered ranges of motion thresholds (C3/C4 alterations) were identified: 113.2° for flexion, 130.0° for rotation and 90.2° for lateral flexion.After manipulations, the volunteers who underwent the isometric treatment presented a slight increase in amplitude for lateral flexion (p < 0.04), which was not found in the volunteers who underwent the placebo treatment. Compensatory motions showed differences pre and post isometric treatment without reaching significant values. ConclusionPrincipal ranges of motion were found significantly higher after osteopathic treatment when compared to the placebo treatment. Osteopathic palpatory diagnosis showed significant correlation with range of motions before treatment.

Efficacy comparison between microscope-assisted atlantal pedicle screw placement by hand and drill for unstable atlas burst fracture

Objective To investigate the efficacy of microscope-assisted free-hand atlantal pedicle screw technique for unstable atlas burst fracture. Methods A retrospective case control study was conducted to analyze the clinical data of 48 patients with unstable atlas burst fracture admitted to Ningbo No.6 hospital from January 2016 to June 2018. There were 32 males and 16 females, aged 24-72 years [(49.5±15.2 years)]. A total of 22 patients were treated with the technique of atlas screw placement by drill under microscope (Group A), including 14 males and eight females, aged 24-68 years. Twenty six patients (Group B) were treated with atlantal pedicle screw placement by hand, including 18 males and 8 females, aged 26-72 years [(50.7±15.4 years)]. The operation time, intraoperative blood loss and the times of intraoperative fluoroscopy were compared between the two groups. X-ray and CT were reexamined to evaluate the accuracy of screw placement within one week after operation. The visual analogue score (VAS) and cervical dysfunction index (NDI) were compared before operation and 1 year after operation. The intraoperative complications were recorded. One year after operation, X-ray and CT were reexamined to observe fracture healing, atlantoaxial fusion and failure of internal fixation. Results Group A was followed up for 12-24 months [(18.4±6.8)months], and Group B for 12-24 months [(17.4±7.2)months]. The amount of intraoperative bleeding [(180.5±60.8) ml] and the times of intraoperative fluoroscopy [(1.3±0.8) times] in Group A were significantly lower than those in Group B [(280.1±80.2) ml, (2.2±0.8) times] (P 0.05). There were statistically significant differences in VAS and NDI before operation and one year after operation in both groups (P 0.05). No serious complications such as vertebral artery, nerve root and spinal cord injury occurred. One year follow-up CT showed healed fracture or continuous bone bridge passing through the atlantoaxial intervertebral space. Except for one patient in Group B with lost reduction, other patients had no loosening or fracture of internal fixation. Conclusion Compared with screw placement by hand, the pedicle screw placement by drill under the microscope can reduce the amount of bleeding and the times of fluoroscopy. Key words: Atlanto-occipital joint; Fracture fixation, internal; Pedicle screws

Comparing the range of musculoskeletal therapies applied by physical therapists with postgraduate qualifications in manual therapy in patients with non-specific neck pain with international guidelines and recommendations: An observational study

The aim of this study is to compare Dutch usual care musculoskeletal therapy in patients with non-specific neck pain with recommendations from international clinical practice guidelines. Physical therapy is diverse, as it may consist of exercise, massage, advice, and other modalities. Physical therapists with post graduate qualifications in manual therapy (MT) may additionally apply spinal thrust manipulation or non-thrust mobilization techniques to treat neck pain. It is important that, in the absence of a Dutch clinical guideline for the treatment of patients with neck pain, musculoskeletal therapists use the available recommendations from international clinical practice guidelines when treating patients with neck pain. One updated clinical practice guideline was identified (Blanpied, 2017), a report from the Task Force on Neck Pain (Guzman et al., 2008) and the IFOMPT International Framework for Examination of the Cervical Region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy Intervention (Rushton et al., 2014). At baseline 1193 patients are included and data with regard to pain, disability, fear avoidance, expectations and applied treatment modalities are gathered. Outcome is measured using the Global Perceived Effect questionnaire. Results show that patients with acute neck pain are treated significantly more often with manipulation compared to patients with sub-acute or chronic neck pain (p < .000) and younger patients are treated with manipulation more often than older patients (p < .000). In the presence of comorbidity, the preference of spinal manipulation seems to diminish, in favour of mobilization and exercise. Almost every patient receives multimodal therapy (94.3%) and spinal manipulation and mobilization are rarely used as a stand-alone treatment (4.5% and 0.8%). Dutch musculoskeletal therapists choose treatment strategies that correspond with recommendations from international guidelines.

Comparison of two methods of cervical spine pain manual therapy using clinical and biochemical pain markers

Background. Sedentary lifestyle, often associated with faulty posture is a widespread facilitating factor for cervical spine dysfunction (CSD). Objective. The purpose of our study was to compare two methods of physical therapy for CSD: the McKenzie method and suboccipital relaxation. We investigated the effect of these methods on pain level perceived by patients and their physical fitness. The levels of biochemical stress indicators were assessed. Materials and methods. Eighty-six adult patients divided into two groups: A and B. Group A included 42 patients treated with the McKenzie method. Group B consisted of 44 patients, who underwent suboccipital relaxation. The treatment in both groups comprised 3 treatment sessions over a 6-week period. To assess salivary sIgA concentration, the ELISA technique was used. The alpha-amylase activity was determined using static method. Pain assessment was performed using the VAS scale. Disability level was evaluated with the NDI scale. Results. Significant decrease of VAS and NDI scores were observed in both groups. An increase of sIgA concentration was observed in both groups. No difference in amylase activity between the groups was observed, however, time and group effects the interaction was found to be significant. A significant correlation between both biochemical markers and VAS score was observed in group B and in the general population. Conclusions. Both therapies improve patient outcomes, however, at present we cannot indicate the advantage any method.

Bilateral atlantoaxial lamina hook and atlantoaxial joint space screw for the treatment of acute type I transverse ligament injury in school-age children

To evaluate the effect of bilateral atlantoaxial lamina hook and atlantoaxial joint space screw combined with autologous iliac bone graft on atlantoaxial dislocation caused by acute type I transverse ligament injury in school-age children. From February 2006 to February 2019, 8 school-age children with atlantoaxial dislocation caused by acute type I transverse ligament injury were systematically reviewed, including 6 males and 2 females; aged 9 to 12 years old; 8 acute injuries included 4 high-level falls, 2 car accidents and 2 sports injuries; the atlantoaxial interval(ADI) was 5 to 8 mm. Eight cases presented with pain, stiffness, numbness and cervical spine dysfunction in different degrees. Two of them were accompanied by nerve compression and ASIA grade D. The preoperative C₁,₂ angle averaged 20.7° to 23.4°. All patients received cranial traction and surgical treatment after complete reduction or atlantoaxial reduction. The changes of Japanese Orthopaedic Association(JOA) score, space available for the cord(SAC), neck disability index(NDI), ADI, ASIA classification(ASIA) injury classification(1992) and C₁,₂ angle before and after treatment were observed. The average follow-up time was 8 to 156 months. Clinical and radiological follow-up showed that the atlantoaxial joint was completely relieved, the reduction was satisfactory and the arthrodesis was stable. Nerve and vascular injuries associated with this technique were not observed. JOA score, SAC, NDI, C₁,₂ angle of the last follow-up of the children were significantly improved. Two children of ASIA grade D recovered to grade E. Bilateral atlantoaxial lamina hook and atlantoaxial joint space screw combined with autologous iliac bone graft is simple, less bleeding, strong stability and high fusion rate. It is an ideal surgical procedure for acute type I transverse ligament injury with atlantoaxial dislocation in school-age children.

SYMPTOM INSTABILITY AND A PROPOSED CLASSIFICATION SYSTEM FOR THE PHYSICAL THERAPY MANAGEMENT OF SPORTS-RELATED CONCUSSION

Individuals can experience headaches, dizziness, cervical dysfunction, balance disturbances, fatigue, and oculomotor impairments following a concussion. Patients with sports-related concussions are not a homogenous group but rather heterogenous groups with mixed clinical findings. The purpose of this clinical commentary is to propose a classification system developed specifically for the physical therapy management of sports-related concussions. The concept of "symptom instability" was introduced to assist with classifying patients. The time period post-concussion, symptom instability, and the ability to identify symptom triggers were used as defining criteria. The end result was a classification system with five clinical subgroups. The classification system assists in forming homogeneous groups. The grouping of patients into these subgroups can allow for improved efficiency of organizing treatment plans. 5.

Analysis of the application effect of the deer of Wu Qin Xi in the rehabilitation of elderly patients with cervical spondylotic radiculopathy

Objective To investigate the effects of deer play of Wu Qin Xi on cervical mobility, TCM symptoms and anxiety in elderly patients with cervical spondylotic radiculopathy. Methods Sixty patients with orthopaedic inpatients from June 2017 to June 2018 were enrolled. In the 6 to December 2017, 30 inpatients who met the criteria were selected as the control group, and 30 patients who met the criteria from January to June 20 were the intervention group. Two groups of patients were treated with conventional nursing, and the intervention group was treated with deer play on the basis of the control group. Cervical dysfunction index (NDI) was compared before intervention, 2 weeks and 4 weeks after intervention; clinical symptoms and signs and neck activity were compared before intervention and 2 weeks after intervention; anxiety scores were compared before intervention and after 4 weeks of intervention (GAD-7). Results The NDI scores of the intervention group were 19.23±2.19 and 9.23±1.85 at 2 and 4 weeks respectively. The scores of the control group were 21.37±1.40 and 11.63±2.95, respectively. The difference was statistically significant (t=3.77-4.49, P<0.05). After 2 weeks of intervention, the clinical symptoms and signs and neck activity of the intervention group were 5.47±1.78, 19.17±1.26, 4.87±0.78, 11.50±1.46, the control group were 7.40±2.53, 16.23±1.87, 6.17±1.26, 13.17±1.56, and the difference between the two groups was statistically significant (t=-7.12-4.81, P<0.05). After 4 weeks of intervention, the GAD-7 score of the intervention group was 1.07±0.20, and the control group was 1.56±0.29. The difference between the two groups was statistically significant (t=6.55, P<0.05). Conclusion Luxi can improve the symptoms of neck pain in elderly patients with cervical spondylotic radiculopathy, improve cervical function and relieve anxiety. Key words: Nursing care; Wu Qin Xi; Nerve root type cervical spondylosis; Old age

To investigate the efficacy of cervical external fixation after cervical single-segment anterior fusion

Objective This study was to investigate the necessity of wearing a cervical collar after single-segment anterior cervical discectomy and decompression. Methods The experimental methods were used to group the two wards in the same department. There were 54 patients in the experimental group and 48 patients in the control group. The patients in the experimental group did not wear the cervical collar during the postoperative outpatient activities and after discharge. The control group patients wore the cervical collar within 3 months after walking and after discharge. The cervical dysfunction index of the two groups before surgery and 3 months after surgery was compared between the two groups; also vertebral fusion at 6 months postoperatively; and SF-36 (Quality of Life Assessment Scale) scores before surgery and 3 months after surgery. Results The NDI of the experimental group was significantly lower than that of the preoperative NDI (20.62%±1.94% vs 26.06%±2.17%) (t=18.32, P<0.01). The NDI of the control group was 3 months after operation compared with the preoperative NDI (21.30±%1.87% vs26.26%±2.74%) also had a significant decrease (t=16.67, P<0.01). The NDI of the experimental group was significantly lower than that of the preoperative NDI (14.97%±1.85%vs26.06%±2.17%) (t=31.93, P<0.01), the NDI of the control group was significantly lower than that of the preoperative NDI (15.98%±1.49% vs26.26%±2.74%) at 6 months after operation (t=24.45, P<0.01). The difference was statistically significant. The SF-36 score in the last 3 months was higher than that in the control group (53.37±9.23 vs 45.77±8.07), and the difference was statistically significant (t=4.40, P<0.01). Conclusions Compared with the external fixation without neck and neck, the treatment of cervical external fixation does not affect the postoperative treatment effect, and can improve the quality of life of patients. Key words: Cervical external fixation; Anterior cervical discectomy and fusion; Effectiveness

Effect of laparoscopic cervical cerclage combined with comprehensive nursing intervention on the mood and quality of life of the patients with cervical incompetence

Objective To discuss the influence of laparoscopic cervix cerclage combined with comprehensive nursing intervention on patients' mood and quality of life in cervical incompetence. Methods A total of 33 cases of cervical dysfunction patients who underwent pre-pregnancy cyclization from August 2015 to September 2017 were selected as the research group. A total of 63 cases of cervical dysfunction patients who underwent cyclization during the second trimester of the same period were selected as the control group.The average operation time, the time of hospitalization, the emotional changes before and after treatment, and the quality of life score of the two groups of patients were compared. Results No infection was found in the research group after operation, while that in the control group was 14.28% (9/63), and the difference was statistically significant (P<0.05). The mean operation time and hospitalization time in the research group were shorter than those in the control group, and the differences were statistically significant(P<0.05). After intervention, the decrease degree of Self-rating Anxiety Sale (SAS) and Self-rating Depression Scale (SDS) and increase degree of WHOQOL score were better than those of the control group, and the differences were statistically significant(P<0.05). Conclusions Laparoscopic cervical cerclage can improve the success rate of operation for patients with cervical insufficiency, and combined with comprehensive nursing intervention, it can effectively relieve patients' mood and improve their quality of life. Key words: Laparoscope preconception cervical cerclage; Cervical incompetence; Comprehensive nursing intervention; Mood; Quality of life

Thoracic Posture and Mobility in Mechanical Neck Pain Population: A Review of the Literature.

Neck pain is a common condition with several proposed biomechanical contributing factors. Thoracic spine dysfunction is hypothesized as one of the predisposing factors, which necessitates the need to explore the contribution of thoracic posture and mobility toward neck pain. Accordingly, the present work aimed to review the existing literature investigating the presence of thoracic spine dysfunction in individuals with neck pain. A literature search was conducted in the three electronic databases of PubMed, CINAHL, and Web of Science. Studies published between 1990 and 2017 were considered. After reviewing the abstracts, two authors independently scrutinized the full-text documents for their relevance. The initial search yielded 2,167 articles, of which nine studies involving comparisons of neck pain patients and healthy controls were identified for the review. Increased thoracic kyphosis was positively correlated with the presence of forward head posture but not uniformly associated with neck pain intensity and disability. Thoracic mobility was reduced in the neck pain population, and the role of thoracic kyphosis as a risk factor for pain development could not be confirmed. Thus, an association exists between thoracic kyphosis and postural alteration in the cervical spine. The review favors the inclusion of thoracic spine assessment and treatment in mechanical neck pain patients. Further studies are needed to investigate the cause-effect relationship between thoracic posture and cervical dysfunction.

Outcome of Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy

Background: Cervical spondylotic myelopathy (CSM) is a progressive degenerative disease and the most common cause of cervical spinal cord dysfunction (SCD) in older patients. Anterior cervical discectomy andfusion (ACDF) is a common procedure for patients with severe neurological deterioration. The goals of this study were to evaluate the clinical and functional outcome, radiological fusion and operative complications in case of CSM who underwent ACDF by autogeneous-tricortical bone graft and stabilized with plate and screws.&#x0D; Methods: This prospective interventional study was carried out at National Institute of Traumatology and Orthopaedic Rehabilitation ( NITOR) and different private hospitals in Dhaka from January 2012 to December 2014. Within this period total 12 CSM patients were included as study sample. All were surgically treated by ACDF and stabilized by plate and screws. All patients were clinically and radiologically evaluated before and after surgery.&#x0D; Results: Single level ACDF by autograft and stabilization by plate and screws was done in 10 (83.33%) patients and 2 (16.67%) patients had two level fusion. The mean follow up period was 12 months. The satisfactory result was found in 10 (83.33%) patients. Post-operative complications were donor site morbidity in2 (16.67%) patients and transient dysphagia in 1 (8.33%) patient. The fusion rate was 100% in this series.&#x0D; Conclusion: ACDF with anterior plating for CSM is a safe and effective procedure. It results in highest fusion, least complication and relatively lower cost.&#x0D; Birdem Med J 2019; 9(2): 133-137

Manual therapy for the pediatric population: a systematic review

BackgroundThis systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found, and synthesizes findings based on health condition. We also assessed the reporting of adverse events within the included studies and compared our conclusions to those of the UK Update report.MethodsSix databases were searched using the following inclusion criteria: children under the age of 18 years old; treatment using manual therapy; any type of healthcare profession; published between 2001 and March 31, 2018; and English. Case reports were excluded from our study. Reference tracking was performed on six published relevant systematic reviews to find any missed article. Each study that met the inclusion criteria was screened by two authors to: (i) determine its suitability for inclusion, (ii) extract data, and (iii) assess quality of study.ResultsOf the 3563 articles identified, 165 full articles were screened, and 50 studies met the inclusion criteria. Twenty-six articles were included in prior reviews with 24 new studies identified. Eighteen studies were judged to be of high quality. Conditions evaluated were: attention deficit hyperactivity disorder (ADHD), autism, asthma, cerebral palsy, clubfoot, constipation, cranial asymmetry, cuboid syndrome, headache, infantile colic, low back pain, obstructive apnea, otitis media, pediatric dysfunctional voiding, pediatric nocturnal enuresis, postural asymmetry, preterm infants, pulled elbow, suboptimal infant breastfeeding, scoliosis, suboptimal infant breastfeeding, temporomandibular dysfunction, torticollis, and upper cervical dysfunction. Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Twenty studies reported adverse events, which were transient and mild to moderate in severity.ConclusionsFifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed.Trial registrationPROSPERA registration number: CRD42018091835

Cervical Spine Dysfunction Following Pediatric Sports-Related Head Trauma.

To examine the prevalence of cervical spine injuries among children and adolescents referred with suspected and diagnosed sports-related concussion (SRC); and evaluate the effect of cervical spine dysfunction (CSD) on physician-documented clinical recovery following SRC. A multidisciplinary pediatric concussion program. A total of 266 patients (6-19 years) referred with suspected SRC. A retrospective cohort study. CSD defined as neurological symptoms localized to the cervical spine or the presence of neck pain, headache, or dizziness and abnormal cervical spine examination findings; physician-documented clinical recovery. One patient was diagnosed with a T1 compression fracture. Of the 246 patients diagnosed with SRC, 80 (32.5%) met the clinical criteria for CSD including 4 patients with central cord neuropraxia and 1 with a spinal cord injury without radiographic abnormality (SCIWORA). Excluding patients with central cord neuropraxia OR SCIWORA, patients with SRC with CSD took longer to achieve physician-documented clinical recovery (28.5 days vs 17 days, P < .0001) and were 3.95 times more likely to experience delayed physician-documented clinical recovery (>4 weeks postinjury) compared with those without CSD. Patients with suspected and diagnosed SRC can present with a wide spectrum of coincident cervical spine injuries. Cervical spine dysfunction may be a risk factor for delayed clinical recovery.