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Flashcards in Module 4 Deck (68)
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1
Q

TMJ is:

a) synovial
b) ginglymoarthrodial
c) hinge and glide joint
d) all of the above

A

d

2
Q

TMJ muscles

protrusion: 1
retraction: 4
elevation: 3
depression: 3

A

protrusion - lateral ptery

retraction - temporalis masseter (deep), geniohyoid, digastric

elevation - temporalis, masseter, medial ptery

depression: digastric, geniohyoid, mylohyoid

3
Q

Unilateral contraction of the ______ ptery will cause medial movement of the mandible.

A

medial

4
Q

What is unique about the superior part of the lateral ptery?

A

disc

5
Q

With bilateral contraction, the hyoid bone is fixed by ________and _______. The mandible is depressed and pulled backward

When the mandible is fixed, the __________ muscles elevate the hyoid bone, which is necessary for swallowing

A

With bilateral contraction, the hyoid bone is fixed by suprahyoid and infrahyoid. The mandible is depressed and pulled backward

When the mandible is fixed, the digastric muscles elevate the hyoid bone, which is necessary for swallowing

6
Q

TMJ - fibrocartilaginous

T or F: hyaline lining thus making it better to repair and less susceptible to aging and wearing

T or F: temporomandibular ligament is the thinnest in the lateral capsule to prevent compression of the retrocondyle material

A

Fibrocartilaginous surfaces, not hyaline!
Advantages:
Less susceptible to aging and breaking down over time
Better ability to repair vs hyaline

Has an articular disc (meniscus) that divides the joint into a superior and inferior compartments (cavities)
Disc: Firm, oval, fibrous plate

F - thickest

7
Q

TMJ

________ occurs in the inferior cavity

________ occurs in the superior cavity

A

rotation (hinge)

translation (gliding)

8
Q

TMJ is innervated by what two nerves?

T or F: poorly vascularized

A

auriculotemporal + massenteric nerve (V3)

F - HIGHLY vascularized!

9
Q

TMJ - which ligament gets stretched when you yawn?

outer oblique portion
inner horizontal portion

A

OOP

10
Q

the OPP of the temporomandibular ligament limits _______ opening; this is only found in humans and it prevents what?

A

limits ROTATIONAL

impingement

11
Q

Biting down hard on one side (power stroke) increases pressure on __________ side and decreases pressure on the _________ side

A

Biting down hard on one side (power stroke) increases pressure on contralateral and decreases pressure ipsilateral

12
Q

If locking occurs in the open position, probably due to…..

Pain with biting small firm objects, probably an…..

Pain on full opening, probably due to an….

A

If locking occurs in the open position, probably due to subluxation of the joint (anterior to eminence)

intra-articular

extra-articular

13
Q

“Soft” or “popping” clicks occur due to…….

“Hard” or “cracking” clicks related to….

“Soft” crepitus (rubbing knuckles together) is……

“Hard” crepitus (footstep in gravel) is indicative of…..

A

muscle incoordination.

joint surface defects

normal

arthritic changes

14
Q

T or F: TMJ issues are usually multifactorial. Acupuncture can help it significantly

A

T

15
Q

What do you need to predict muscle force from EMG? (5)

A
muscle length
velocity on contraction
PEC
Po = newtons/cm2
(EMG/EMGmvc)
16
Q

What is the problem with EMG signal quality?

A

You want to enlarge it without distorting its shape

17
Q

T or F: Biological freq: 10-500 Hz

A

T

18
Q

What is aliasing?

A

Sample frequency - signal frequency = alias frequency
eg.
EMG highest frequency = 500 Hz
If you sample at 800 Hz, your 500 Hz component will masquerade as 800-500 = 300 Hz

19
Q

What does the CMRR do?

A

cut out the noise

common mode rejection ratio

20
Q

EMG

T or F: Without normalization you cannot compare between muscles, days, conditions or left and right sides

A

T

21
Q

with fatigue - frequency shifts to the _____

A

LEFT

22
Q

So what are cativations?

A

A suction cup holds because the air pressure inside the “cup” is lower than the atmospheric pressure outside it.

When it is released, those two regions of pressure rapidly equilibrate, and the pressure wave of this air flow produces an audible sound. - quora.com

23
Q

From the Humphreys study (motion palpation with those with congenital block vertebra), what was the result?

A

SMT did not significantly decrease pain/stiffness hours, evening post manipulation. but this study DID NOT rule out the efficacy of endplay assessments for LT therapy for pain/stiffness

24
Q

Leboeuf-Yde study:

What did they assume in terms of LBP and fixations?

But what did they find?

A

This is what they assumed

If you have a LBP today – you have a fixation
If you have LBP in a week – you may or may not have a fixation = STAIRCASE FORMATION

what they found: FALSE! Even people who did not have back pain had fixations. According to their hypothesis (bottom bar should be 100%, top bar should be 0%)

conclusion: maybe those who have restrictions but no pain….are still on their way to experiencing pain symptoms

25
Q

T or F: when it comes to tests, the more you use in combo with each other, the better you are at getting the diagnosis right

A

T

26
Q

All of these are “unfavourable” uses to determine site of care - except

manual muscle testing
skin temperature
ortho tests
surface EMG
postural
A

ortho tests

“Most convincing favourable evidence for methods which confirmed or provoked pain at specific spinal level or region”
Tenderness, Orthopaedic tests, ROM, Mackenzie, painful arch (flex-ext), prone instability

High quality evidence supporting the use, with limitations of static (unclear) and motion palpation (limited to region of the spine, direction of movement and method employed), and leg length inequality (pelvic assessment, not feet)

27
Q

Schiller, 2001 - Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine

Between the 4 manipulation techniques: bilat (1 hand), cross bi, unilat, from behind.

Pain, disability (oswestry), algometer, goniometer

Findings?

A

Long term changes with SMT (effect on pain at final Tx, lateral FL ROM, local sensitivity)

28
Q

Bronfront, 2001 - Efficacy of spinal manipulation for chronic headache

Compared to massage, did SMT have a better effect? Which types of headaches respond well?

T or F: CCA now recommends SMT for tension headaches

A

Yes - for cervicogenic/tension headaches

FALSE - Tension type - SMT NOT RECOMMENDED, but not recommended againsT. Low load craniocervical exercise (resistance, therabands) – 10 min. 2x/day for 6 weeks, then 2x/wk for 6 months

29
Q

McMorland and Suter, 2000 - Chiropractic management of mechanical neck and low back pain: A retrospective, outcome-based analysis.

Main problem with this study and why it is weak?

They went through old files.

What did they find?

A

retrospective

S/S effect for pain and disability

but SMT for chronic LBP - not work well.

SMT for neck pain - all good

Subjects with neck pain and headaches don’t respond as well as those with neck pain only

30
Q

Koes, 1996

Spinal manipulation for low back pain: An updated systematic review of randomized clinical trials.

A

“The efficacy of manipulation for acute low back pain has not been convincingly demonstrated with sound RCTs…not established for chronic conditions either”
Aka - we did not have enough RCTs in support of SMT

“Certainly are indications that manipulation might be effective in some subgroups of patients with low back pain.”
But we do not know who they are

More research is needed

31
Q

Chaitow et al. 2004 Efficacy of manipulation in low back pain treatment: The validity of meta-analysis conclusions

A

Conclusions:
Back pain populations are not homogeneous making it difficult to compare like with like
Practitioners have hugely varied levels of skill and training and use a variety of techniques
RCTs are not ideal for measuring SMT due to difficulties noted above and control grouping
When appropriately selecting the “clinical prediction rule”, patients show a very high positive response to SMT
Lack of proof of efficacy does not prove a method is ineffective, only that proof is lacking

32
Q

Bronfort, 2003 - efficacy of SMT and mobs for LBP and NP

RCTs including 10 or more subjects per group receiving SMT or MOB and outcome measures (eg, patient-rated pain, disability, global improvement and recovery time).

69 RCTs met selection criteria, were reviewed and assigned validity scores varying from 6 to 81 (scale of 0 to 100).

43 RCTs met the admissibility criteria for evidence.

SO….results?

A

///We are just as good as drugs! We may be more expensive than drugs; but in the long-run we may be cheaper///

Moderate evidence that SMT provides more short-term pain relief than MOB and detuned diathermy

Limited evidence of faster recovery than a commonly used physical therapy treatment strategy.

Moderate evidence SMT is:
Similar effect to prescription NSAID
SMT/MOB is effective vs. placebo and general practitioner care (short term)
Better than Physical therapy (long term)

Limited to moderate evidence:
SMT is better than physical therapy and home back exercise (short and long term)

Limited evidence:
SMT is superior to sham SMT and chemonucleolysis for disc herniation in the short term

However, there is also limited evidence that MOB is inferior to back exercise after disc herniation surgery.

33
Q

Bronfort, 2011 - Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial

Supervised exercise therapy (SET)
Spinal manipulative therapy (SMT)
Home exercise and advice (HEA)

Which one was better?

A

All 3 groups improved after 12 week tx period.
However, satisfaction was the only significant difference between groups.
Patients in the SET were the most satisfied, then SMT, least was HEA
Note: SET had the most contact time

34
Q

Flynn et al. (2002) A Clinical Prediction Rule for Classifying Patients with Low Back Pain Who Demonstrate Short-Term Improvement With Spinal Manipulation

4/5 of the criterion will increase success of SMT from 45% to ___%

What are the 5 criteria?

A

4/5 will increase probability of success with SMT from 45% to 95%

Segmental hypomobility/pain upon springing palpation over lumbar facets
Acute onset of pain <16 days
No pain distal to the knee
At least 1 hip internal rotation > 35 degrees
Low fear avoidance beliefs score (FABQ)

35
Q

Fritz, 2005

Those who did not get better where actually put into the WRONG GROUP. (ie. someone who was hypomobile was put into the stabilization group)

LBP Hypomobile category subjects experienced greater benefit from the __________+ _________

LBP Hypermobile category subjects were more likely to benefit from a _____________

A

LBP Hypomobile category subjects experienced greater benefit from the manipulation + stabilization

LBP Hypermobile category subjects were more likely to benefit from a stabilization exercise program.

36
Q

Brennan, 2006 - identifying subgroups of patients with acute/subacute “nonspecific” LBP

Results

A

The short and long-term outcomes did not differ based on group, or the subgroup, but depended on the interaction between treatment group and subgroup, such that patients receiving matched had better outcomes

Developing methods to subgroup patients with “nonspecific” low back pain can improve the outcomes of care.

37
Q

If a patient has pain that centralizes with movement in extension and peripheralize with movement in flexion, which type of treatment would be best for this patient?

a) Manipulation
b) Core stabilization
c) Manipulation with core stabilization
d) Specific directional exercise (McKenzie)

A

d

38
Q

Fritz, 2005 - pragmatic application of clinical predictions rules…

A

Therefore:
Sensitivity is not good (poor at predicting who will not have success)
Specificity is excellent (great at predicting success)

The high specificity (0.92) and positive likelihood ratio (7.2) indicate that patients with both criteria present should be referred for a manipulation intervention based on the high likelihood of rapid success.

The sensitivity (0.56) and negative likelihood ratio (0.48) associated with this two-criteria rule were only moderate, indicating a relatively high potential for false negative results (i.e., subjects designated as likely non-responders who ultimately experienced success with manipulation).

39
Q

Cleland, 2009 - comparison of the effectiveness of 3 manual PT….

Patients: > 25 Oswestry, 18-60 yrs, positive for SMT prediction rule (4/5)
Randomized into 1 of 3 SMT groups for only first two sessions
Patient received 2 treatments (SMT/mobs) in 1 week
All patients received same exercise regimen in clinic and at home:
Supine pelvic tilt, abdominal hollow, gluteal bridge, bird dog, side bridge.

//Findings?//

A

RATE MATTERS! HVLA was better than mobs.

Results support the hypothesis that the CPR is generalizable to additional thrust manipulation techniques, but not to non-thrust manipulation techniques

Therefore both supine & sidelying SMT work as treatment for the LBP clinical prediction rule.

Limitation: did not use rotational mobs

40
Q

Hicks, 2005 - preliminary development of a clinical prediction rule of determing which patients with LBP…

A

It appears that the response to a stabilization exercise program in patients with LBP can be predicted from variables collected from the clinical examination

Prediction rules could be used to determine whether patients with LBP are likely to benefit from stabilization exercises.

41
Q

Palmieri and Smoyak, 2002 - chronic LBP - manip under anesthesia

SMT completed by specially trained DC & anesthesiologist

1-4 tx per patient over a few days

After which regular SMT and exercise were continued for 4-6 week
Most (87%) of the intervention group had received at least 4 weeks of spinal manipulation (without anesthesia) before the procedure

A

There was more self-reported improvement in the MUA than with traditional chiropractic (this was not reported as SS)

Why?
Better tx under anesthesia?
Chiros in special MUA centre vs Traditional clinic

42
Q

Senna M & Machaly S (2011)

LBP subgroups: 
1. Specific spinal pathology 
2. Nerve root pain/radicular pain or 
3. Non-specific LBP
About 85% of LBP patients who seek treatment do so for the non-specific variety

93 patients, 20-60 yrs
Chronic (>6 mo) non-specific low back pain
3 Groups:
1. Sham SMT – 12 sessions + pelvic ROM ex
2. SMT – 12 sessions + pelvic ROM ex
3. SMT – 12 sessions + pelvic ROM ex + SMT every 2 weeks for additional 9 months

SMT was bilateral

A

Chronic LBP patients who received maintenance care over a 10-month period had better results regarding post-treatment pain and disability levels than patients who stopped treatment after 1 month of care.

The maintenance care patients also had improved lumbar mobility and better perceptions of their general health than their no maintenance counterparts.

43
Q

McMorland et al. 2010 - Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.

Inclusion criteria:
Presence of leg-dominant symptoms*
Objective signs of nerve root tethering ± neurologic deficit that correlated with evidence of root compression seen on MRI
Patients must have failed at least 3 months of nonoperative management.

SMT – 20 subjects
Microdiskectomy – 20 subjects
Crossover study

A

SMT: 12/20 (60%) patients demonstrated clear improvement in outcomes at the end of 12 weeks

8/20 (40%) patients in this group did not respond to SMT very well and opted for the microdiskectomy procedure

LDH patients who have failed at least 3 months of nonoperative medical management, (analgesics, lifestyle mods, physiotherapy, RMT, and/or acupuncture), should consider chiropractic SMT, followed by surgery if unsuccessful.

Patients in this study were considered surgical candidates, yet they improved with SMT in a similar manner to those who underwent surgery.

44
Q

Wainner, 1994 developed a clinical prediction rule for cervical radiculopathy:

Which 4 ortho tests?

A

spurling
distraction
ULTT
<60 deg cervical rotation ROM

45
Q

Tseng, 2006

Purpose
SMT in the neck has worked for some but not all
Who responds immediately to SMT in those with neck pain?

  1. Initial Neck Disability Index <11.50 (3.84)
  2. Bilateral involvement pattern (4.40)
  3. Not performing sedentary work >5 h/day (9.07)
  4. Feeling better while moving the neck (9.42)
  5. Without feeling worse while extending the neck (5.85)
  6. Diagnosis of spondylosis without radiculopathy (7.22)

(# in brackets) = odds ratio

A

“These results implied that when a patient has at least 3 of the predictors identified in this prediction model, cervical manipulation should be attempted because the patient may have a chance of over 73% to respond immediately to the treatment.”

46
Q
age
gender
pain intensity
duration of current episode
psychological status

Which one of these are not predictive of success of Smt

A

all of them are not predictors

47
Q

PREDICTORS FOR IMMEDIATE AND GLOBAL RESPONSES TO CHIROPRACTIC MANIPULATION OF THE CERVICAL SPINE – Thiel & Bolton 2008

Objective
Identify predictors for improvement or worsening with cervical SMT

Presenting symptoms of:
Neck pain (4.63)
Shoulder, arm pain (2.36) 
Reduced movement/stiffness: neck, shoulder and/or arm (16.33)*
Headache (3.05) 
Upper, mid back pain (4.08) 
none or one presenting symptom (1.58) 
- (Stats, not really a predictor) 

These emerged in the final model as significant predictors for an immediate improvement.

Presence of any 4/5 of these predictors raised the probability for an immediate improvement in symptoms after treatment from 70% to ~___%. Paradoxically, with all 5 predictor variables, the post prediction probability fell to 60%

A
*stiffness was the strongest predictor of success
# in brackets = Odds ratio

Presence of any 4/5 of these predictors raised the probability for an immediate improvement in symptoms after treatment from
70% to ~95%

Paradoxically, with all 5 predictor variables, the post prediction probability fell to 60%

48
Q

Liguo Z, Wei X, Wang S. 2015. Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis

3 RCT
502 patients with degenerative cervical radiculopathy
ages 45 to 53.6 years
All three studies included a manipulation group and a control group (all providing mechanical cervical traction)

Cervical SMT types:
Rotation
rotation-traction
fix-point traction (not further defined)

A

The authors were able to conduct a meta-analysis, demonstrating the superiority of cervical manipulation compared to mechanical traction for improving pain measured with the VAS immediately after treatment.
The evidence was judged to be of moderate quality.

Thoughts: More research is needed to compare SMT with alternative treatments other than cervical computerized traction

49
Q

Development of a Clinical Prediction Rule for Guiding Treatment of a Subgroup of Patients With Neck Pain: Use of Thoracic Spine Manipulation, Exercise, and Patient Education - JA Cleland, JD Childs, JM Fritz, JM Whitman, SL Eberhart 2007

Purpose: no studies have looked at predictive validity of variables to identify patients with neck pain who would benefit from THORACIC SMT

A

42/78 had a successful outcome (54%)
CPR with 6 variables was identified

If 3 of 6 variables (positive likelihood ratio=5.5) were present, the chance of experiencing a successful outcome improved from
54% to 86%

Good study identifying predictors of success for neck pain sufferers using THORACIC SMT

Excellent use of pictures in the paper!

50
Q

This study examined the effect of translatoric spinal manipulation (TSM) on cervical pain and cervical active motion restriction when applied to upper thoracic (T1-T4)

Measures:
Active cervical ROM - cervical inclinometer (CROM)
Cervical pain – Pre & Post via Faces Pain Scale
Convenience sample (19-50 years)
32 patients pain in the mid-cervical region and restricted active cervical rotation
22 patients randomly assigned to experimental group (2nd day)
10 were assigned to the control group (no treatment)

A

Cervical rotation range of motion improved in all subjects following the application of this form of manipulation to the UT (T1-4) segments.

No patient reported any increase in cervical symptoms post-manipulation.

51
Q

Purpose:
To assess the effectiveness of thoracic manipulation (TM) on patients with chronic neck pain

120 pts (18-55 years) with chronic neck pain (> 3 mo)
Randomized into 2 groups

Group 1: T/S SMT + infrared radiation (15 min) + educational material
Group 2: No SMT + infrared radiation (15 min) + educational material

Treatment: 2x/week, 8 sessions total
SMT = anterior-posterior approach
An audible crack/pop was heard during all SMTs

A
This study shows that thoracic SMT was effective in improving:
neck pain (at rest)
improving dysfunction 
neck posture (CV angle)
neck range of motion (ROM)

for patients with chronic mechanical neck pain immediately and up to a half-year post-treatment.

52
Q

SMT and EMG response?

17 Subjects (9 males) (14 LBP, 3 thoracic pain below T4)

Painful/tender segment identified for EMG electrode placement over erector spinae

  1. Normalized EMG via 30 degree forward isometric bend holding 5 kg load
  2. Upright stance
  3. Lay prone with a calibrated force algometer vertically over tender segment with no force applied
  4. Lay prone with calibrated force algometer over tender segment with slow ramped force applied until subject reported pain and held for minimum 8 seconds peak force recorded.
  5. Two minutes rest (no EMG)
  6. Lay prone with a calibrated force algometer over non-tender segment with no force applied
  7. Lay prone with calibrated force algometer over non-tender segment with slow ramped force applied until subject reported pain and held for minimum 8 seconds peak force recorded. (Same as painful segment)
  • Randomization: some patients had the order of painful vs non-painful testing reversed.
A

Motion segments identified as painful have an exaggerated local muscle response to a painful stimulus compared with the response at the segments that were not painful.

SMT appears to attenuate the EMG response to a pain stimulus

This possibly lead to sustained muscle contraction and ischemic muscle pain, further adding to the reflex reaction to increase muscle activation.

The control of this reflex system undergoes central sensitization

This study suggests that SMT may interrupt the pain-spasm cycle by down-regulating the central sensitization

53
Q

Sung, 2004 - Effect of Spinal Manipulation Duration on Low Threshold Mechanoreceptors in Lumbar Paraspinal Muscles: A Preliminary Report

Hypothesis: SMT excites nerves:
Neural responses arising from the mechanical input during spinal manipulation are thought to contribute to this maneuver’s therapeutic effects. Quickly stretching the receptors with SMT, may cause a neural response & therapeutic effect

PURPOSE: DOES SPEED MATTER?

Experiments were performed on 6 anesthetized adult cats.

A

Figure 3 shows how the 6 impulse durations affected each afferent’s discharge.

At rest the 6 afferents had a mean resting IF of 18 Hz.
Change with impulse durations:
SLOW - 800 ms increased afferent discharge to 27 Hz on average.
FAST – 200 ms increased afferent discharge approx. 3X (74 Hz)
SUPER FAST - 25-ms nearly 12X (327 Hz) higher than @ 800-ms

IF = impulse frequency

Impulse-induced increases in IF remained relatively constant during the longer impulse durations (800 and 400 ms) when compared to the shorter durations (100, 50, and 25 ms).

Generally, the change in mean IF increased abruptly as the impulse duration shortened.

Does Loading Magnitude Matter?

NO

Figure 5 illustrates that increases in loading magnitude (33% vs. 66% vs. 100% body weight) did not appear to systematically affect the discharge from the 6 threshold mechanoreceptors.

This preliminary study suggests that primary afferents respond to SMT in some unique way because abrupt changes in discharge frequency occurred as the duration of spinal manipulation approached that described for clinical practice (30-400 ms)

Further studies to understand the signaling properties of a wider range of sensory receptors is warranted.

54
Q

Multi-direction thrust on cats, measuring impulse frequency

18 cats, muscle spindle activity measured
HVLA spinal manipulation applied over skin
Force applied
Perpendicular
15 degrees (medially & cranially)
30 degrees (medially & cranially)

*Normal force was kept constant

A

Results:
No difference in Δ Mean Impulse Frequency for any of the thrust directions during the HVLA-SM

Conclusion:
The shear force component of an HVLA-SM’s thrust vector is not transmitted to the underlying vertebra sufficient to activate muscle spindles of the attached muscles.

55
Q

Whittingham, 2001 - Active Range of Motion in the Cervical Spine Increases After Spinal Manipulation (Toggle Recoil)

Randomization by blinded drawing of patients names from a box.
The trial was conducted over 12 weeks

Phase 1 -3 weeks of baseline observation, both groups Phase 2 -3 weeks, Group 2: SMT (upper cervicals, 3x/wk) and Group 1 sham manipulation, 3x/wk 9 (sham = weird impulse gun thing)
Phase 3 -3 weeks, Group 2: no treatment, Group 1: SMT, 3x/wk
Phase 4 -3 weeks, Group 2: sham manipulation, 3X/wk Group 1: no treatment.

A

Consistent and statistically significant increase in active ROM in the cervical spine after SMT.
Group 2 showed lasting ROM increase (6 weeks)

Did not include flexion or extension.

Take home message:

Spinal manipulation of the cervical spine (toggle recoil) increases ACTIVE range of motion.

56
Q

Cramer, 2000 - Effects of Side-Positioning and Side-Posture Adjusting on the Lumbar Zygapophysial Joints as Evaluated by Magnetic Resonance Imaging: A Before and After Study With Randomization

What side is being adjusted/gapped in side-postures?

A

There was difference between the left Z joint of subjects who received SMT and remained in side-posture positioning (group 3, 0.7 mm) and those of the control group (group 4, 0mm)

There was difference between the left Z joint of subjects that did not receive SMT but was scanned in side-posture (group 1, 0.4mm) and control group (group 4)

No difference between the group that received SMT and placed supine (group 2) and control (group 4)

Therefore only temporary change in joint space

//////Side posture – UPSIDE is being gapped//////

Lumbar side-posture SMT produces gapping of the Z joints.

Side-posture positioning (alone) produces gapping, but less than after SMT.

Thus, side posture SMT would appear to be able to break up adhesions within hypomobile joints.

Larger clinical trial should be performed (They did – RCT with 64 subjects in 2002, confirmed these results)

Side Posture Lumbar Manipulation gaps the upside joints

57
Q

Cramer, 2011 - Evaluating the relationship among cavitation, zygapophyseal joint gapping, and spinal manipulation: An exploratory case series

5 healthy subjects were recruited from a university student population: 4 males
MRI
Accelerometer data to locate cavitation origin

A

Greater gapping of the L4-5 and L5-S1 levels were found in the facet joints which received spinal manipulation compared to the those that did not (0.5 mm +/- 0.6mm)

Also, UP-SIDE L4-5 and L5-S1 joints which cavitated at those levels gapped more than up-side joints which did not cavitate at those levels (0.8 mm +/- 0.7mm versus 0.4 mm +/- 0.5mm).

Clear trend for increased joint gapping of facet joints that received manipulation and cavitated compared to joints that did not cavitate

Larger (at least 40 + 10 control) study needed

SMT may work through:
the break-up of connective tissue adhesions within the joint
stimulation of afferent nerve fibers in the joint capsule or surrounding musculature
a neurological or immunological reflex

58
Q

T or F: preggo women get into more MVAs

A

5 years, 507 262 women gave birth in Ontario
6922 motor vehicle crashes (177 per mo) in 3 years prior
757 motor vehicle crashes in second trimester (252 per mo)

42% relative increase!

But a Drop in third trimester

59
Q

T or F: drop in preload can aid in the adjustment

A

yes - for the sake of acceleration

60
Q

T or F: By chance chiropractors use 90N when manipulating the cervical spine Compare that to disc loads during active ROM (ext-flex). Manipulation is only ½ the force naturally seen by the disc

A

That info is true but

People who think we apply excessive forces through the neck….FALSE. Look at the forces from the research data

61
Q

cSMT - T or F: contact was on the left, rotate right, right cavitates

A

Forty-seven of the fifty subjects (94%) exhibitedcrackingon the ipsilateral side to head rotation

Only 1 practitioner manipulated all 50 subjects

REMEMBER THIS STUDY***

Ie. contra to contact hand; ipsi to rotation you’re trying to go. One of the few studies that looks which side cavitates during a cervical SMT

Cavitation was significantly more likely to occur unilaterally,
and on the side contralateral to the short-lever applicator contact, during cervicothoracic HVLA thrust manipulation.
Clinicians should expect multiple cavitation sounds when performing HVLA thrust manipulation to the CTJ.

62
Q

SONG et al. 2015 ATTENUATION EFFECT OF SPINAL MANIPULATION ON NEUROPATHIC AND POSTOPERATIVE PAIN THROUGH ACTIVATING ENDOGENOUS ANTI- INFLAMMATORY CYTOKINE INTERLEUKIN 10 IN RAT SPINAL CORD

A

Repetitive Activator-assisted spinal manipulative therapy significantly reduced:
Simulated neuropathic and postoperative pain
Inhibited or reversed the neurochemical alterations
Increased the anti-inflammatory IL-10 in the spinal cord

63
Q

What do you know now?

Increase ROM
Improve neck posture*
Decrease EMG of paraspinals
Decrease pain caused by algometer (pressure)
Decrease disability (NDI, Oswestry)
SMT may interrupt the pain-spasm cycle (neuro modulation)
SPLM gaps facet joints on the up side
Cervical rotary SMT cavitates the opposite side of contact
Palpation on it’s own is not sufficient to base SMT decisions on
Reduce pain and inflammation (animal model)

A

kk

64
Q

Evidence for treatment
Cervicogenic Headaches
Migraines
Tension type headaches
Neck pain – especially those fitting into clinical prediction rule
Thoracic pain
Low back pain – especially those fitting into clinical prediction rule
Acute responds better than chronic
Chronic low back pain – Maintenance SMT (every 2 weeks)
Guiding treatment with prediction rules improves success outcomes
Clinical practice guidelines

A

kk

65
Q

At what angle of unilateral cervical spine rotation did Selecki report “kinking” of the ipsilateral vertebral artery at C1-C2?

A) 25 degrees
B) 30 degrees
C) 40 degrees
D) 45 degrees

A

Kinking: Contra: 30 degrees, Ipsi: 45 degrees
Toggle recoil – improved active ROM
Peak rotational moment: Long lever 35
Open jaw lock - subluxation

66
Q
Whittington and Nilsson (2001) studied active ROM following a cervical spine manipulation.  What type of manipulation was applied?

A) Rotary
B) Lateral break
C) Toggle recoil
D) Activator
A

Kinking: Contra: 30 degrees, Ipsi: 45 degrees
Toggle recoil – improved active ROM
Peak rotational moment: Long lever 35
Open jaw lock - subluxation

67
Q
Triano and Shultz (1997) analyzed peak load component amplitudes (MOMENTS) of the mamillary push, lower SI (hypothenar ischial) and the long lever lumbar spine adjustments.  Which of these adjustments was found to create the greatest peak rotational moment?

a) Mamillary push at 90 degrees
b) Lower SI at 35 degrees
c) Lower SI at 90 degrees
d) Long lever at 35 degrees
A

Kinking: Contra: 30 degrees, Ipsi: 45 degrees
Toggle recoil – improved active ROM
Peak rotational moment: Long lever 35
Open jaw lock - subluxation

68
Q

If locking of the TMJ occurs in the open jaw position, what is the MOST likely cause?

a) Condyle trapped posterior to the disc
b) Subluxation of the joint
c) Masseter muscle spasm
d) Pterygoid muscle spasm

A

Kinking: Contra: 30 degrees, Ipsi: 45 degrees
Toggle recoil – improved active ROM
Peak rotational moment: Long lever 35
Open jaw lock - subluxation