Spinal Mobility Research Articles

Cervical and thoracic/lumbar motion and muscle strength in surgically treated adolescent idiopathic scoliosis patients.

To date, only one study assessed the spinal mobility and muscle strength of patients who were treated either with fusion or brace treatment. The aim of this retrospective study was to evaluate the range of motion (ROM) and strength of the cervical and thoracic/lumbar spine in patients who underwent spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) in comparison to healthy individuals. Patients (n= 28) who were treated surgically for AIS were included in the study. An age and gender matched control group (n= 22) was included that consisted of healthy individuals. DAVID® Lumbar/Thoracic Extension, Lumbar/Thoracic Rotation, and Cervical Extension/Lateral Flexion devices were used to measure cervical and lumbar/thoracic ROM as well as muscle strength. Significant differences were observed between groups in all ROM measurements except thoracic/lumbar sagittal flexion ROM measurement (p= 0.198). There were significant differences between groups in terms of muscle strength, except thoracic lumbar left rotation strength (p= 0.081). The findings of the current study demonstrated that cervical and thoracic/lumbar range of motion, as well as muscle strength, were significantly decreased in surgically treated adolescent idiopathic scoliosis patients compared to healthy counterparts. However, trunk (thoracic/lumbar) flexion range of motion and trunk left rotation muscle strength were not significantly different.

Assessment of value of protraction angle and functional disorders of motion segments of cervical spine in bus drivers

Introduction: Cervical segment is a part of the spine which is the most exposed to stress and dysfunction. Aim: The aim of the study is to analyze the body posture of bus drivers and, especially, functional assessment of cervical spine mobility segments. Material and methods: The study included a group of 40 people, consisting of professionally active drivers working in public transport, 20 of whom were the men under 40, and the remaining 20 were the men over 40. The study used the original study card. Results: There was dependence between the subjects' length of service and the appearance of hand numbness. There was dependence between protraction angle and length of service. Most of the study subjects (67.5%) report the presence of back pain syndromes. Among the study subjects, 45.0% declare that they do sports / physical activity improving their condition. In the case of rectus abdominis muscle strength, the majority of the surveyed (60.0%) cannot sit unassisted. Conclusions: The bus driver is exposed to a lot of stress every day, resulting, i.a. from the responsibility he bears for passengers in the vehicle, as well as from heavy traffic, which leads to changes in myofascial tensioning, resulting in the incidence of pain.

Anterior vertebral body tethering as a treatment for scoliosis in skeletally immature patients

A relatively new surgical procedure called Anterior Vertebral Body Tethering (AVBT) is used to treat scoliosis in patients with immature skeletons. It is a growth modulation fusionless system that Crowford and Lenke first described in 2010. We present our observations from 25 patients. Improvement in the mean coronal Cobb angle, from mean 57° preoperative to mean 34° postoperative, was 40%. Additionally, we noted that the mean thoracic hypokyphosis improved from 16° to 24° on average after surgery. Complication rates were 16% and surgical revision rates were 12%. All patients who demonstrated improvement in pain, function, and self-image underwent administration of the SRS-24 questionnaire. These data, according to the literature, show that AVBT is a reliable technique that enables scoliosis correction in skeletally immature patients and maintains that correction while utilizing remaining growth potential to achieve further correction, avoiding spinal fusion, and maintaining spine mobility.

Correlation between sensitization and range of motion in children and adolescents with migraine

IntroductionMigraine affects 7.7% of children and adolescents and presents with short duration, bilateral and generally frontotemporal localization, however, the relationship of pain and sensitivity symptoms and their correlations with physical tests as well as range of motion are not well understood in these groups. ObjectiveCorrelate sensitization including allodynia and pressure pain threshold (PPT) of cervical muscles with neck mobility in children and adolescents with migraine. MethodsFifty children (CH) and adolescents (AD) diagnosed with migraine by ICHD-III were screened, of both sexes, aged between 6 and 17 years at the tertiary headache outpatient clinic. Allodynia was assessed by the adapted allodynia questionnaire based on the ICHD-III and the sensitivity of the cervical muscles sternocleidomastoid, elevator, suboccipital, trapezius and scalene by the pressure pain threshold (PPT) using a digital algometer DDK-20 Kratos®. The active mobility of the cervical spine (ROM) was evaluated in the movements of flexion, extension, lateral flexion, and rotation by the Flexion Rotation Test (FRT), using the CROM®. ResultsThe mean age of patients was 11.7 years (SD=3.0), most of them female (n=31/62%), adolescents (n= 28/56%) with a diagnosis of episodic migraine (n=32/64%), of low intensity (2.4; SD=0.6), pulsatile quality, duration in hours (18.0; SD=22.7) and more than half of the sample had no aura (n=32/64%). More than 70% of the sample had some comorbidity associated with the diagnosis of migraine, and neurological diseases, such as epilepsy, were more prevalent in both children (25.2%) and adolescents (26.3%), followed by respiratory diseases in children (20.1%) and psychological conditions in adolescents (19.8%). (To see the complete abstract, please, check out the PDF).

Manual Physiotherapy Combined with Pelvic Floor Training in Women Suffering from Stress Urinary Incontinence and Chronic Nonspecific Low Back Pain: A Preliminary Study.

Stress urinary incontinence (SUI) represents one of the most common subtypes of urinary incontinence (UI) reported by women. Studies have shown an association of SUI with nonspecific low back pain (NSLBP). The primary aim of the present study was to explore the long-term effects of a combined treatment of manual techniques and pelvic floor muscle (PFM) training in women suffering from SUI associated with NSLBP. The secondary aim was to evaluate which manual approach combined with PFM rehabilitation is more effective in improving symptoms related to SUI and in reducing pain perception related to NSLBP. Twenty-six patients suffering from SUI associated with chronic NSLBP were randomly assigned to one of two groups: the postural rehabilitation group (PRg) or the spinal mobilization group (SMg). Both groups performed a manual approach combined with PFM rehabilitation. All patients were evaluated before the treatment (T0), after 10 sessions (T1) and after 30 days from the end of the treatment (T2). The results showed an improvement in both groups in all of the investigated outcomes. Combining manual therapy and PFM training within the same therapy session may be useful for improving both SUI and NSLBP and increasing the quality of life of women suffering from SUI associated with NSLBP.

Effect of Activity (ADL) Modification on Reduction of Pain in Patients with Chronic Non-Specific Low Back Pain

Introduction & Objective: : Low back pain is the commonest cause of activity limitations and absence of work in developing country like Bangladesh. The aim of this study was to chalk out the association between ADL modification with chronic low back pain. Materials & Methods: : This Randomized Clinical Trial was performed in the Department of Physical Medicine and Rehabilitation, JRRMCH, Sylhet. Eighty patients of 30 to 60 years old, fulfilling the selection criteria were included in this study. Patients were divided into two groups after randomization by lottery method. Patients of Group-A were treated with NSAID, Anti-ulcerant & Activity (ADL) Modification while patients of Group-B were treated with NSAID and Anti-ulcerant only. Patients of both groups were treated for six weeks. Main outcome measures were Subjective Pain Intensity Score, VAS, Tenderness Index, Disability due to pain, Spinal Mobility Index and Oswestry Disability Index. Results: Majority of the patients of both groups were 30 to 40 years old (52.5% in Group-A and 47.5% in Group-B). Males were predominant in both groups. While majority belongs to middle socio-economic class, occupationally farmers were majority in both groups (22.5% in Group-A and 20% in Group-B). VAS was better in patients who received instructions about activity (ADL) modification than those who did not receive them. Subjective Pain Intensity Score and Tenderness Index improved in both groups but their difference was not statistically significant. Disability due to Pain and Spinal Mobility Index, both the variables improved at the end of 3rd week and their difference was statistically significant (P<0.05). Conclusion: From the study it can be concluded that Activity (ADL) Modification helps to reduce pain in patients with chronic non-specific low back pain. Medicine Today 2022 Vol.34(2): 140-144

Spinal stability analysis of lumbar interbody fusion according to pelvic type and cage angle based on simplified spinal model with various pelvic indices.

Recently, the objectives of lumbar interbody fusion (LIF) have been extended to include the correction of broader/relative indications in addition to spinal fixation. Accordingly, LIF must be optimized for sagittal alignment while simultaneously achieving decompression. Therefore, a representative model classified into three pelvic types, i.e., neutral pelvis (NP), anterior pelvis (AP), and retroverted pelvis (RP), was selected according to the pelvic index, and LIF was performed on each representative model to analyze Lumbar lordosis (LL) and the corresponding equivalent stress. The finite element (FE) model was based on a sagittal 2D X-ray image. The calculation efficiency and convergence were improved by simplifying the modeling of the vertebral body in general and its posterior portion in particular. Based on the position of the pelvis, according to the pelvic shape, images of patients were classified into three types: AP, RP, and NP. Subsequently, representative images were selected for each type. The fixation device used in the fusion model was a pedicle screw and a spinal rod of a general type. PEEK was used as the cage material, and the cage shape was varied by using three different cage angles: 0°, 4°, and 8°. Spinal mobility: The pelvic type with the highest range of motion (ROM) for the spine was the NP type; the AP type had the highest LL. Under a combination load, the NP type exhibited the highest lumbar flexibility (LF), which was 2.46° lower on average compared to the case where a pure moment was applied. Equivalent stress on the spinal fixation device: The equivalent stress acting on the vertebrae was lowest when cage 0 was used for the NP and AP type. For the RP type, the lowest equivalent stress on the vertebrae was observed when cage 4 was used. Finally, for the L5 upper endplate, the stress did not vary significantly for a given type of cage. In conclusion, there was no significant difference in ROM according to cage angle, and the highest ROM, LL and LF were shown in the pelvic shape of NP type. However, when comparing the results with other pelvic types, it was not possible to confirm that LF is completely dependent on LL and ROM.

The Journey to Diagnose Spondyloarthritis in Patients From Riyadh: A Cross-Sectional Study.

Introduction Ankylosing spondylitis, now frequently referred to as spondyloarthritis (SpA), is a chronic inflammatory disease causing axial arthritis andinflammatory lower back pain resulting in the eventual impairment of spinal mobility. Moreover, its systemiccomplications include stiffness and inflexibility, restriction of lung capacity and function, eye inflammation, compression spinal fractures, and heart problems. Hence,early diagnosis and intervention play a key role in preventing acute complications and improving the quality of life. Objective We aimed to estimate the average duration of diagnosis, the average number of doctors visited, and the association between the specialty of the first physician and the length of SpA diagnosis delay. Methods A cross-sectional retrospective study was conducted from November 2019 to April2020 with patients from King Khalid University Hospital, Riyadh, Saudi Arabia. The patients were 18 years and older and diagnosed with SpA. Call interviews were conducted and patients'medical charts were reviewed. The data were analyzed using the Statistical Package for Social Sciences statistical software, version 23 (IBM Corp., Armonk, NY). Result The total sample was 101 patients: 59 (58.4%) males and 42 (41.6%) females. The average duration from the onset of symptoms until seeking medical advice (lag 1) and from seeking medical advice until the definite diagnosis (lag 2) was 24.74 ± 48.13 and 16.16 ± 34.62 months, respectively. The average number of doctors visited between the first medical encounter and the final diagnosis was 3.56 ± 5.3. Patients who consulted rheumatologists as the first medical encounter showed less delay in diagnosis compared to patients who sought non-rheumatologists, such as orthopedists, emergency physicians, and general physicians(11.81 ± 33.35 months vs. 26.63 ± 44.28, 26.96 ± 44.88, and 44.33 ± 65.75 months, respectively). Conclusion Patients with SpA who were not seen by rheumatologists took a longer period till the final diagnosis than those who visited rheumatologists earlier in the course of the disease. Therefore, more studies are required to define the exact factors leading to the delay.

Experimental Analysis of Handcart Pushing and Pulling Safety in an Industrial Environment by Using IoT Force and EMG Sensors: Relationship with Operators’ Psychological Status and Pain Syndromes

Non-ergonomic execution of repetitive physical tasks represents a major cause of work-related musculoskeletal disorders (WMSD). This study was focused on the pushing and pulling (P&P) of an industrial handcart (which is a generic physical task present across many industries), with the aim to investigate the dependence of P&P execution on the operators’ psychological status and the presence of pain syndromes of the upper limbs and spine. The developed acquisition system integrated two three-axis force sensors (placed on the left and right arm) and six electromyography (EMG) electrodes (placed on the chest, back, and hand flexor muscles). The conducted experiment involved two groups of participants (with and without increased psychological scores and pain syndromes). Ten force parameters (for both left and right side), one EMG parameter (for three different muscles, both left and right side), and two time-domain parameters were extracted from the acquired signals. Data analysis showed intergroup differences in the examined parameters, especially in force integral values and EMG mean absolute values. To the best of our knowledge, this is the first study that evaluated the composite effects of pain syndromes, spine mobility, and psychological status of the participants on the execution of P&P tasks—concluding that they have a significant impact on the P&P task execution and potentially on the risk of WMSD. The future work will be directed towards the development of a personalized risk assessment system by considering more muscle groups, supplementary data derived from operators’ poses (extracted with computer vision algorithms), and cognitive parameters (extracted with EEG sensors).

Jaw and neck muscle activity during chewing and craniocervical dysfunction index in children, adolescents, and adults with and without cystic fibrosis: a comparative analysis

ABSTRACT Objective To compare masticatory muscle activity between people with cystic fibrosis (pwCF) and healthy controls and to verify whether craniocervical dysfunction is associated with the presence of CF. Methods Fifty-six participants were assessed and divided into pwCF and healthy control (HC) groups, each one composed of 13 children and adolescents at 9 (SD 3) years old and 15 adults at 25 (SD 6) years old. Craniocervical Dysfunction Index assessed symptoms of dysfunction and cervical spine mobility. Electromyography was used to evaluate the jaw and neck muscle activity during chewing. Results Muscle activity during chewing was not statistically different between groups. Prevalence of craniocervical dysfunction was 75% for pwCF vs 64% for healthy controls. Individuals with CF are 1.53 [1.260, 1.870] times more likely to have reduced cervical mobility compared to healthy controls (p = 0.000). Conclusion These results reinforce the need for musculoskeletal disorders treatment in the management of pwCF.

Effects of Brief Intervention of Behavioural Change on Pain, Mobility, Function, and Quality of Life in Patients with Chronic Ankylosing Spondylitis: A Randomised Clinical Trial

Background: Exercise is essential for maintaining the flexibility and functionality of the joints in patients with ankylosing spondylitis. Additionally, it could ease pain, enhance posture, correct muscular imbalances, facilitate breathing, and generally enhance the quality of life. However, since patient education is poorly structured, patients fail to consider this significant element. Objective: To determine the effects of brief intervention of behavioural change on pain, mobility, function, and quality of life in patients with chronic ankylosing spondylitis Methods: This was a randomized controlled trial with 80 patients in two groups: brief intervention and control. Purpose sampling was used to enrol ankylosing spondylitis patients aged 18 to 60 with stable medical management. Patients with respiratory, cardiac, neurological, pregnancy, or inability to walk unassisted were excluded. All participants provided written informed consent. Cardiorespiratory test duration, physical activity duration per week, flexibility measured by chest expansion, back pain usual, back pain at night, global disease activity, Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Quality of Life (ASQoL) scale. Week 0 before treatment, 6th week end, and 12th week follow-up were assessed. Data was analysed in SPSS 25.0. Results: The results showed that the demographic variables were equally distributed in both groups without a significant association to any group (p value >0.05) except for urban residence where urban residents were having more percentage of ankylosis spondylitis. The results regarding outcome variables post-interventional 8th week showed that Cardiorespiratory test duration 881±(47.23) and 812±(56.89), Flexibility, chest expansion 6.7±(2.75) and 5.2±(2.14), Back pain usual 2.7±(0.79) and 3.4±(1.04), Back pain at night 3.8±(1.78) and 4.4±(1.54), Global disease activity 6.2±(1.97) and 6.7±(2.03), Bath Ankylosing Spondylitis Functional Index (BASFI) 7.4±(1.16) and 7.2±(1.69) and Ankylosing Spondylitis Quality of Life (ASQoL) scale 12.6±(1.25) and 15.7±(1.05). while the p value (<0.05) showed significant difference in favour experimental group, brief intervention for all variables. Similarly, the follow up results measured at 16th week were significantly different in favour experimental group, brief intervention for all variables, p value (<0.05 Conclusion: The findings of study concluded that brief intervention-based health improving physical activity was significantly on pain, mobility, function, and quality of life in patients with chronic ankylosing spondylitis. Keywords: Brief Intervention, Physical Activity, Ankylosing Spondylitis, Back Pain, Spinal Mobility

The deer play in Wuqinxi and four-point hand-knee kneeling positions for training core muscle function and spinal mobility.

The four-point kneeling exercise is a core stabilization exercise that provides the spine with dynamic stability and neuromuscular control. In the traditional Chinese exercise Wuqinxi, deer play is performed in a hand−foot kneeling (HFK) position, which is remarkably similar to the four-point hand−knee kneeling (HKK) position. However, the differences in spinal function promotion between these two positions are poorly understood. The aim of this study was to investigate muscle activation patterns and spinal kinematics during specific core stabilization training to provide evidence for selecting specific exercises. A total of 19 healthy adults were recruited to perform HFK and HKK. The rotation angle of the C7–T4 vertebra and the surface EMG signals of abdominal and lumbar muscles on both sides were collected. The paired t-test showed that the vertebral rotation angles were significantly higher during HKK than HFK, and the intra-group differences mainly occurred at the level of the thoracic vertebra. The muscle activation of both sides of the rectus abdominis and external oblique in HFK was significantly higher than in HKK when the upper limb was lifted (p < 0.05). The activation of the ipsilateral lumbar multifidus and erector spinae muscles was significantly higher during the HKK position than during HFK when the lower limb was lifted (p < 0.05). HFK provided more training for strengthening abdominal muscles, while HKK could be recommended for strengthening lumbar muscles and increasing spine mobility. These findings can be used to help physiotherapists, fitness coaches, and others to select specific core exercises and develop individualized training programs.

THE EFFECT OF SLING-BASED MANUAL THERAPY AND STABILIZATION EXERCISE FOR IMPROVING CERVICAL ALIGNMENT AND MOBILITY IN INDIVIDUAL WITH FORWARD HEAD POSTURE

Individual that greater use of information and communication technologies such as computer, smartphone, or other media has the tendency failure of body postures. Laptop usage has been associated with adolescent neck pain, with daily use of computers exceeding 2-3 hours as a threshold to forward head posture. Forward head posture can affect the result of reducing cervical alignment and mobility of the neck. There are exercises that intention to improving the cervical alignment and mobility, particularly sling-based manual therapy and stabilization exercise. A sling device provide the research subject with optimal loading of each target segment, in actual neutral position, and an environment for exercise in a closed kinetic chain. Spinal mobilization techniques used in manual spinal treatment activate the descending pathway from the peritubular gray region (PAG) of the midbrain. Moreover, stabilization exercise affect postural control through concurrent contractions of the agonist and antagonist muscles to improving cervical alignment and mobility.&#x0D; Key Words: Sling; Manual Therapy; Stabilization Exercise; Cervical Alignment; Cervical Mobility; Forward Head Posture

The effects of clinical pilates training on disease-specific indices, core stability, and balance in patients with ankylosing spondylitis

ObjectiveTo assess the effects of clinical Pilates training on disease-specific indices, core stability, and balance in ankylosing spondylitis (AS) patients. MethodsAS patients were randomly assigned to either the Pilates group (PG) or control group (CG). The PG participated in Pilates training 3 times a week for 8 weeks. Patients in the CG were instructed to follow a home exercise program for 8 weeks. Assessments were performed before and after the interventions. BASDAI, BASFI, BASMI, and the AS Quality of Life (ASqOL) questionnaire were used were used to evaluate disease activity, functionality spinal mobility and quality of life respectively. Static core endurance was assessed with trunk flexor, extensor endurance, and lateral bridge tests, while dynamic core endurance was assessed using modified sit-up test. Balance was evaluated with bilateral and unilateral stance static postural stability (PS), bilateral stance dynamic PS and limits of stability (LOS) tests using the Biodex Balance System. ResultsTwenty-one patients in the PG and 21 patients in the CG completed the study. PG showed statistically significant improvements in BASDAI, BASFI, BASMI, and ASQoL scores, all core endurance tests, and dynamic PS and LOS results. The CG demonstrated significant improvement only in flexor endurance and LOS results. Post-intervention BASDAI, BASMI, and all core endurance tests were significantly better in the PG than in the CG (p < 0.05). ConclusionPilates training has positive effects on disease activity and functional capacity, spinal mobility, core endurance, balance, and quality of life in AS patients. Clinicaltrials.gov identifierNCT04292028.

Sulphurous Crenotherapy Is Effective at Reducing Pain and Disability in Overweight/Obese Patients Affected by Chronic Low Back Pain from Spine Osteoarthritis.

Crenotherapy is recognized as being effective in patients with osteoarthritis of the spine, but to date there is no indication if it is effective for patients who are overweight or obese. The aim of this study is to evaluate the efficacy of sulphurous crenotherapy on pain and disability in overweight/obese subjects affected by chronic low back pain from spine osteoarthritis. Forty-three patients (63 ± 8.8 years) affected by chronic low back pain from lumbar spine osteoarthritis were enrolled in this study. Subjects were treated with 2 weeks of sulphurous creno-treatments. Subjective pain was measured by a numerical rating scale score (NRS), and functional mobility of the lumbar spine was measured using the Oswestry Disability Index (ODI) before and after crenotherapy. Both crenotherapy groups (normal weight: A1; overweight/obese: A2) experienced significantly improved NRS and ODI scores (A1: p < 0.001 and p = 0.001; A2: p = 0.001 and p = 0.001). At end of the treatment, significant improvements were observed as a result of the crenotherapy in overweight/obese subjects in terms of pain reduction measured with NRS (p = 0.03) and in terms of function mobility of the lumbar spine measured with ODI (p = 0.006). This study highlights the beneficial effect of sulphurous crenotherapy on the painful symptomatology and disability in both normal weight and overweight/obese patients suffering from chronic low back pain associated with lumbar spine osteoarthritis.

Differences in spinal posture and mobility between children/ adolescents with obesity and age‑matched normal‑weight individuals

Differences in spinal posture and mobility between children/ adolescents with obesity and age‑matched normal‑weight individuals

Differences in spinal posture and mobility between children/adolescents with obesity and age-matched normal-weight individuals

The aim of this study was to cross-sectionally explore the association of obesity with spinal posture and mobility, commonly associated with musculoskeletal problems, by comparing the spinal parameters between 90 obese and 109 normal-weight children and adolescents. A non-invasive electromechanical device, the Idiag M360 (Idiag, Fehraltorf, Switzerland), was used to measure the spinal parameters. An age-and-sex-adjusted two-way analysis of variance (ANOVA) was used to determine postural and mobility differences between the two groups. Children and adolescents with obesity had significantly greater thoracic kyphosis [difference between groups (Δ) = 13.00, 95% CI 10.10–15.80, p < 0.0001] and thoracic extension (Δ = 6.50, 95% CI 2.90–11.60, p = 0.005), as well as smaller mobility in thoracic flexion (Δ = 5.00, 95% CI 1.20–8.80, p = 0.01), thoracic lateral flexion (Δ = 17.70, 95% CI 11.60–23.80, p < 0.0001), lumbar flexion (Δ = 12.10, 95% CI 8.70–15.50, p < 0.0001), lumbar extension (Δ = 7.10, 95% CI 3.10–12.20, p = 0.003) and lumbar lateral flexion (Δ = 9.10, 95% CI 5.50–12.80, p < 0.0001) compared to the normal-weight children and adolescents. These findings provide important information about the characteristics of the spine in children and adolescents with obesity and unique insights into obesity-related mechanical challenges that the spine has to withstand and strategies designed to improve spinal mobility in this young population.

In vivo measurement of intradiscal pressure changes related to thrust and non-thrust spinal manipulation in an animal model: a pilot study

BackgroundThe intervertebral disc is a known back pain generator and is frequently the focus of spinal manipulative therapy evaluation and treatment. The majority of our current knowledge regarding intradiscal pressure (IDP) changes related to spinal manual therapy involves cadaveric studies with their inherent limitations. Additional in vivo animal models are needed to investigate intervertebral disc physiological and molecular mechanisms related to spinal manipulation and spinal mobilization treatment for low back disorders.MethodsMiniature pressure catheters (Millar SPR-1000) were inserted into either the L4-L5 or L5-L6 intervertebral disc of 3 deeply anesthetized adult cats (Oct 2012-May 2013). Changes in IDP were recorded during delivery of instrument-assisted spinal manipulation (Activator V® and Pulstar®) and motorized spinal flexion with/without manual spinous process contact.ResultsMotorized flexion of 30° without spinous contact decreased IDP of the L4-L5 disc by ~ 2.9 kPa, while physical contact of the L4 spinous process decreased IDP an additional ~ 1.4 kPa. Motorized flexion of 25° with L5 physical contact in a separate animal decreased IDP of the L5-L6 disc by ~ 1.0 kPa. Pulstar® impulses (setting 1–3) increased IDP of L4-L5 and L5-L6 intervertebral discs by ~ 2.5 to 3.0 kPa. Activator V® (setting 1–4) impulses increased L4-L5 IDP to a similar degree. Net changes in IDP amplitudes remained fairly consistent across settings on both devices regardless of device setting suggesting that viscoelastic properties of in vivo spinal tissues greatly dampen superficially applied manipulative forces prior to reaching deep back structures such as the intervertebral disc.ConclusionsThis study marks the first time that feline in vivo changes in IDP have been reported using clinically available instrument-assisted spinal manipulation devices and/or spinal mobilization procedures. The results of this pilot study indicate that a feline model can be used to investigate IDP changes related to spinal manual therapy mechanisms as well as the diminution of these spinal manipulative forces due to viscoelastic properties of the surrounding spinal tissues. Additional investigation of IDP changes is warranted in this and/or other in vivo animal models to provide better insights into the physiological effects and mechanisms of spinal manual therapy at the intervertebral disc level.

The short-term effect of a myofascial protocol versus light touch applied to the cervical spine towards the prevention of balance disorders in the elderly: protocol of a randomised controlled trial

BackgroundFalling is a major trauma that can occur with aging, leading to very significant psychological and physical health effects with financial and societal consequences. It is therefore essential to explore therapeutic treatments that can reduce this risk. Some recognized effective treatments exist, concerning in particular the re-education of the muscles of the lower limbs. However, to our knowledge, none of them focus on the cervical spine although the latter is located at an essential physiological crossroads. Manual therapy, which has already demonstrated its impact on pain and balance parameters in the elderly, could be a painless and non-invasive tool of choice in addressing this problem.MethodsInterventional study (not related to a health product), monocentric, prospective, controlled, randomized double-blind (patient and evaluator performing the measurements). The experiment will take place over three measurement periods on D0, D7 and D21. On D0 subjects will be randomized in 2 groups: experimental and placebo group. Both groups will be assessed on: Short Physical Performance Battery test score, walking speed, lower limb strength, balance, heart rate variability and cervical spine strength and mobility. Then the experimental group will receive a myofascial release protocol applied to the cervical spine and the placebo group will receive a placebo light touch protocol. The intervention will be followed by the same measurements as before. This schedule will be reproduced on D7. On D21, only one assessment will be done.DiscussionThis study started in 2020 but could not go beyond the inclusion phase due to the COVID pandemic. It is envisaged that recruitment could resume during 2022.Trial registration: Registered by the Comité de Protection des Personnes—Sud Méditerranée; under the title “Prévention des troubles de l’équilibre chez le senior: influence de la thérapie manuelle appliquée au rachis sur les paramètres statiques et dynamiques», n° 19.12.27.47.259 in date of February 4, 2020.Registered by ClinicalTrials.gov ID: NCT05475652; under the title « The Influence of Manual Therapy Applied to the Cervical Spine in the Prevention of Balance Disorders in the Elderly (ManEq)”.

Comparison of Routine Physiotherapy with and without Thoracic Mobility Exercises in patients with Chronic Neck Pain

Background: Cervical pain is a perception anywhere in the posterior region of the cervical spine. Aim: To compare the effectiveness of routine physical therapy with and without thoracic mobility exercises in the treatment of chronic neck pain patients. Study Design: Randomized control trail. Methodology: Total of 81 participants having chronic neck were selected with age ranging from 25 to 53 years. NDI and VAS Performa’s were filled according to study protocol. Patients were divided into two groups A (n=41) and B (n=40) and after every four session’s, questionnaires’ were filled and total 12 sessions will be given to each patients. NDI scale and VAS were used as data collection tool. Analysis of data was done by SPSS v.26. Shapiro-Wilk test was applied. Results: Group A consist of n=41, 50.62% of total data and Group B consist of n=40, 49.38% of data as well. In Group-A, minimum age was observed 25 years and 55 years was the maximum age that accounted similarly 20 years was the minimum age of group-B and 52 years was the highest age. Conclusion: It was concluded that people with interminable neck desolation who got the mix of upper thoracic spine preparation and versatility exercise showed better in general transient results as far as the VSA, NDIKey words: Chronic Neck Pain, VSA,NDI and Thoracic Spine Mobility.