SMT Books 1-3 Flashcards
(476 cards)
1
Q
Who mentioned that upper cervical and thoracic HVLAT is more effective than mobilizations?
A
Dunning
2
Q
Who mentioned that HVLAT is a bilateral event?
A
Dunning
3
Q
Do you need a cavitation at C5/6 to elicit increased EMG activity in the biceps, and who discovered this?
A
No, Dunning
4
Q
Who discovered that a HVLAT produces hypoalgesic effects through increased pressure pain thresholds?
A
Cassidy et al.
A CAST will sure as fk increase the pain threshold.
5
Q
Neurophysiologically, Is HVLAT excitatory or inhibitory?
A
There’s conflicting evidence - Peterson et al.
Could never tell if Jordan Peterson is excitatory or inhibited.
6
Q
Who discovered that HVLAT causes a segmental reflexive contraction?
A
Herzog and Simons
- Hazaaah! (Will make you reflexively contract).
7
Q
Who discovered that HVLAT causes an immediate increase in strength?
A
Colloca and Keller
- cool killers have to be strong.
8
Q
CGH - manipulate what?
A
Cervical and Thoracic - Dunning
9
Q
T or F: The intra-articular bubble collapse is all that occurs with a HVLAT?
A
F. Several phenomenon are likely occuring - Dunning.
10
Q
Who discovered that we’re not sure which segments the pops are coming from?
A
Dunning
11
Q
What is Craniopharyngioma?
A
A benign neoplasm and is that to be caused by brain maldevelopment that can occur in children and adults in the seller and/or suprasellar regions - Firas Mourad
12
Q
What did the American College of Physicians say about acute, subacute, and chronic LBP?
A
Acute and subacute: pt’s should select non-pharmacological tx with superficial heat, massage, and acupuncture. No improvement, then add manipulation.
Chronic: a bunch of interventions as well as acupuncture and spinal manipulation.
13
Q
Does the Ontario CPG recommend spinal manipulation for acute and chronic LBP?
A
Yes.
14
Q
What does the European CPG recommend for early management of LBP?
A
Manipulation and acupuncture.
15
Q
Who determined that the 25 CPR’s for PT’s management of LBP are not ready for clinical use?
A
Haskins et al.
- Haskin is askin’ for something better. How bout you do something tho. Shithead.
16
Q
Why are most of the CPRs shit? May and Rosedale 2009
A
None of the studies were of high quality -
- Mayday, we’re going down.
17
Q
What did Stanton et al. In 2010 say about the CPR’s?
A
The reason they’re so shit is because most studies cannot differentiate between predictors or response to treatment and general predictors.
- with stanton he can’t predict what response is gonna happen when he swings
18
Q
Why can’t CPRs be recommended?
A
They are still in their initial development.
- Haskins et al.
Haskin is still askin’
19
Q
Which study, which was published twice, is the only study that shows the “cracking” noise is not necessary?
A
The flynn et al. Study
- Not Necessaey (NN)
20
Q
What did the Hancock et al. Study in 2008 demonstrate regarding the CPR for manipulation?
A
That the SMT CPR could NOT predict who was a good candidate for SMT.
- Hancock. HANCANNOT HAH
21
Q
What did the Reggars study in 1996 discover?
A
On average there’s 2.5 cavitations per thrust.
- Reggars (regular maniper, nothing special)
22
Q
What did Bolton et al. discover with cervical thrusts?
A
With rotational thrusts the cavitation is more likely to occur on the contralateral side.
SB thrusts = on either side.
- BoltON THIS SIDE
23
Q
Dunning in 2013 demonstrated how many pops on average? Is it a bilateral cavitation?
A
6.95 and that it was a bilaterral event. It is no more likely to occur on one side vs. the other.
24
Q
How do Bolton and Dunning’s research differ?
A
Bolton said it was on one side.
Dunning said it was bilateral.
25
How do Dunning and Reggars research differ?
Dunning said 6.95 pops on average
Reggars said 2.5
26
What did Ross et al. Say about the pops?
The more pops, the more likely it came from the targetted joint.
- Ross from friends eventually targetted the right girl.
27
What did Ernst and Canter say about SMT in 2006?
SMT might offer some relief for back pain, but there’s a lack of evidence. They advised caution with cervical manipulations
- Ernst ain’t liking the evidence and Canter cautions cervical.
28
What did the the Cochrane Review in 2010 say about neck pain?
Mod-low quality of evidence that SMT is effective.
29
Dunning et al. Discovered that HVLAT improves RR by ___ and LR by ___. This led to a ____ in motor performance of the deep cervical flexors.
RR: 4.9 degrees
LR: 3.4 degrees
Increase in motor performance.
30
Usworth in 1971 thought the pop orginated from where?
CO2 gas release and said
There’s 15-30 minute refractory period.
31
What did Cascioli et al. in 2003 say the pop was from?
There’s no evidence of a gas release or joint space increase. Instead, it’s the collagen fibers of the articular capsule being stretched.
- A cast involving Coil needs to stretch
32
What did Smith and Bolton in 2013 say regarding WAD?
With non-serious, idiopathic, or WAD (grade II), the use of manipulation for neck pain is at best “empirical.”
Empirical menas based on experience, there’s no evidence to support these claims.
“Smith and western is empirical.”
33
What did Wand et al in 2012 say regarding manipulation of the C spine?
Abondon it. It’s not safe.
Wand waved his wand no.
34
What 3 things did Cassidy in 2012 say regarding manipulation of the C spine?
1. Don’t abandon it. It has significant Short term improvements on disability.
2. It’s better than Medication.
3. There’s no evidence that mobilization is safer or more effecTive than HVLAT.
CAST-SMT
- short term
- medication
- effective
35
What did Michaleff et al. In 2012 say about SMT?
It’s cost effective.
- MichalEFFECTIVE
36
How does SMT relieve pain?
A 1. Manipulation induced Analgesia.
N 2. Non-opiod mechanisms
SN 3. Serotinergic and Nonadrenergic pathways
P 4. Stimulates dPAG-descending inhibition
AN-SNP (Andddd Snap)
37
How does SMT increase circulation?
1. Sympathetic and parasympathetic effects on vasculature.
2. Sympathoexcitatory: decreases skin temperature and increases skin conductance.
38
What is the vascular risk when manipulation the C-spine?
It can vary from 1/50,000 to 1/5.8 million and it may not be cause and effect
39
What did Haldeman and Rubenstein in 1992 estimate the risk of manipulating the c-spine was?
1. Less than 1/10million for VBA/ICA dissection.
2. 3/10M for sudden death
3. There’s no accurate way to assess it.
40
What did Cassidy et al. In 2008 say about VBA?
There’s a stronger correlation PCP visits than chiropractor visits when it comes to VBA dissection. Especially of PCP visits and those < 45 y.o.
41
What did Murphy in 2010 say about screening CAD and VBI Tests?
There’s a lack of reliability of tests and there’s no benefit in screening someone who is at “risk.”
Additionally, VAD is NOT a complication of Cervical Manipulation.
- Murphy, there’s no benefit, no complication
42
What 6 Tests do Kerry and Taylor recommend doing for the assessment of CAD in pt’s presenting with neck pain and a headache?
1. CN and eye exam
2. BP testing
3. Signs of ICA and VA Dissection (non-ischemic and ischemic.
4. PMH atherosclerosis
5. Hand-held doppler Ultrasound
6. Functional CAD positional test (rotation for VA, and extension for ICA).
43
How much strain did Symons et al. Find on the CONTRALATERAL side of the C-Spine during SMT? (Idk which segment they popped)
6.2% at C0-1 loop
2.1% at C6
44
How much strain is required in the VAs before mechanical failure according to Symons et al.?
139-162%
45
What FRACTIONAL force is required for a C-spine manipulation compared to the mechanical failure rate?
1/9th the force
46
What was the conclusion from Symons et al. In 2002 regarding cervical manipulation and VAD?
SMT is very unlikely to mechanically disrupt the VAs
Symon says it won’t cause VAD
47
Austin et al. In 2002 exposed rats to 1000 strain cycle and observed how much microdamage with 6% and 30% force?
6% = no microdamage
30% = significant microdamage, ~50% damage.
48
According to Austin et al. In 2002, What was the average peak forces and speed to the neck during SMT?
Peak force: 100-150N
Speed: 80-150ms
49
Wuest et al. 2010, what was the mean peak force of a neck HVLAT and regular HVLAT?
Neck: 72N
Lumbar: 200N
50
What was the peak VA strain for a c2-3 and c4-5 manipulation in compared to VBI and PROM?
C2-3: 2.2%
C4-5: 3.1%
VBI Testing: 8.5%
PROM: 13%
Thus the VA strain is 1/5th during manipulation compared to neck AROM.
51
Herzog et al. 2012, do trained clinicians strain the VA’s with SMT?
No. The VA is not a factor in VB injuries.
52
Buzzati et al. Can a HVLAT at c1-2 endanger the SC or VA?
No
53
Symons et al. 2012, what was the biomechanical force and speed of a c-spine manipulation in cadavers vs. living subjects?
Cadaver: 284N and 120ms
Living: 190N and 175ms
Conclusion: a thrust on a cadaver is faster and requires more force to cavitate.
54
Thomas et al. Observed how much INFLOW into the brain and how much CHANGE in blood flow when using MRI with cervical rotation, rotation and distraction, C1-2 rotation, and distraction?
- The average inflow into the brain is 6.98 mL/s.
- Blood flow was compensated by a decrease in one vessel resulted in an increase in others.
- Overall, most positions increased overall blood flow.
55
What did Quesnele et al. in 2024 discover with blood blow changes in positions if neutral, 45 deg. rotation, or full rotation?
No significant change in blood flow.
56
What was Hutting et al. findings in 2013 from the VBI literature review?
- quality?
- sensitivty?
- specificity?
1. All questionable quality
2. 0-57% sensitivity (a lot of false-negatives and missed too many patients.
3. 67-100% specificity
57
What did Puentedura et al. in 2012 say regarding the VBI testing?
Regardless of the evidence, or lack thereof, it is the responsibility of the clinician to perform screening examinations and clearly document their use to reduce legal risk.
58
What was Kerry and Taylor’s 6 screening for CAD in pt’s with neck and headache symptoms?
CE BS PUP
1. CN and eye exam
2. BP testing
3. Signs of ICA and VA dissection (non-ischemic and ischemic)
4. PMH of factors related to atherosclerosis
5. Hand-held doppler US
6. Functional CAD positional tests (rotation for VA and extension for ICA)
59
What was Kerry and Taylor’s 3 S&S of Vertebral/CAD?
Cranial and headaches
1. “Head and neck pain that feels like no other.”
2. Fronto-temporal headache, upper cervical, antero-lateral, or postero-lateral neck pain, facial pain, or facial sensitivity
3. CN palsies (9-12)
60
What symptom was found in 82% of ICA dissections?
Horner’s Syndrome
61
What are the 6 symptoms of Horner’s Syndrome?
1. Head, neck, and facial pain
2. Ptosis (drooping eyelid)
3. Enopthalmos (sunken eye)
4. Miosis (small, restricted pupil)
5. Facial dryness
6. Retinal and Cerebral Signs (ICA supplies the retina via the opthalmic artery)
62
3 S&S of VBA Dissection; what is the most prominent sign?
1. 85% - Occipital Headache
2. 67% - Balance or Ataxia problems
3. 25% - Dizziness
Vbad bod
63
4 S&S of ICA Dissection; what is the most common?
When the ICA goes out you lose your HP and feel weak
1. 75% - Retro-orbital or temporal headache
2. 60% - Ptosis
3. 60% - Facial Palsy
4. Limb Weakness (65% upper, 50% lower)
64
What was an unexpected finding from HVLAT regarding facet displacement?
There’s less displacement of facets with HVLAT than mobilizations
65
What was the complication rate of HVLAT from Cassidy et al.?
1/50,000 - 1/4,000,000 and may not be cause and effect.
66
From Purntedura et al 2012, what were the most common adverse events of HVLAT?
1. Arterial Dissection - 37.3%
2. Disc Herniation - 18.7%
3. CVA - 13.4%
4. Dislocation or fracture - 6.7%
5. Death - 5.2%
DDCDD
67
From Purntedura et al 2012, chiropractors cause what percentage of problems?
70%
68
From Purntedura et al 2012, how many deaths from HVLAT were caused by PT’s?
None.
69
What percentage of adverse events were preventable; and what percentage of them had vascular pathologies?
45% - preventable due fo bony or vascular pathologies (severe spondy, osteoporosis, RA, ankylosing soondylitis, cervical stenosis).
20% - inapproprite to manipulate
Thus, 65% of the cases should NOT HAVE BEEN MANIPULATED.
13% vascular pathologies
70
What percentage of adverse events were unpreventable?
10.4%
71
What are Maitland’s Grades of Manipulations?
Grade I: SMALL amplitude at the BEGINNING of the range
Grade II: LARGE amplitude within the MIDRANGE if movement
Grade III: LARGE amplitude at the END range
Grade IV: LARGE amplitude at the END range when tissue is limiting motion (NOT PAIN)
Grade V: SMALL amplitude, quick THRUST manipulation at end range
72
Klein et al., what was the largest and smallest ranges of HVLAT?
Rotation: 12-46 degrees
Lateral flexion: 31-62 degrees
Flexion: 0-23 degrees
- HVLAT should NOT exceed physiological AROM.
73
Who determined that the lateral glide test was valid?
The hypomobile side moved ___ mm less than the contralteral dysfunctional side
Fednandez de las Penas et al. 2005
3.44 mm
74
According to Jull et al. 1994, what percentage of agreement is there between an experienced therapiest and the dysfunctional segment?
94-98%
75
According to Jull et al. in 1997, what was the 3 most dysfunctional segments?
1. C1/2 - 95%
2. C2/3 - 45%
3. C0/1 - 30%
76
Who determined the mean pre-thrust ROM, and what was it?
Klein et al. 2003
Rotational: 30 degrees
Lateral bending: 46 degrees
Flexion: 2 degrees
De-rotation: 5 degrees (come off the barrier)
Mean thrust displacement: 12 degrees
Klein on this line
77
Herzog et al 1993, lateral break technique speed for
Speed to beat?
cervical?
thoracic/SIJ?
135 ms (need for be faster than the biomechancial protective muscular response).
Cervical: 80-100 ms
Thoracic and SIJ: 120-200 ms
78
Who determined that less force and faster speeds are more effective?
Kawchuk et al. 1992
79
Herzog and Simons 2001, mean preload and peak forces?
Preload: 24N
Peak: 238N
80
T or F: A stiff joint requires more preload and thrusting force?
True
81
What is the mean duration of manipulation from contact time to thrust?
7 seconds - Klein et al 2003
82
Is SMT delivered to the target joint?
No - herzog and simons 2001.
83
What is the appropriate amount of skin lock?
33-38 mm - Bereznick et al. 2002
84
What percentage of lumbar manipulations resulted in a single pop vs. multiple pops?
36.5% - single pop
63.5% - 2-6 pops
Ross et al.
85
The SIJ thrust and L5/S1 thrusts cavitated which segment the most often?
SIJ - L5/S1 upside facet
L5/S1 - L3/4 upside facet
- Beffa and Matthews 2004
86
What is the purpose of HVLAT according to Herzog et al. 1993?
1. Restore joint integrity
2. Restore joint ROM
3. Pain reduction via relaxation if hypersensitive muscles
87
Which two studies support putting the SIJ back in place?
CIbulka et al 1998 - found changes in the Innominate post-chicago HVLAT SIJ (pelvic tilting)
Childs et al. 2004b: restoration of bony symmetry 4 days post-chicago HVLAT (iliac Crest Heights)
Triple C’s - chicago, cibulka, childs
88
Which study shows HVLAT does NOT change the SIJ position?
Tullberg et al. 1998
- NOTullberg
89
What did Hungerford et al. 2004 notice in patients with pelvic pain?
The WBing leg does not posteriorly rotate on the symptomatic side.
The pelvis is hung anteriorly
90
What did Timgren and Soinila in 2006 find with leg length discrepancies and iliac crest heights and OA?
ALL patients also had asymmetry of the OA joint via x-ray.
91
Timgren and Soinila 2006, found narrowing between the TP and C1 on the contralateral elevated iliac crest in patients with a _-type scoliosis.
C-type scoliosis on the Contralteral side.
S-type scoliosis on the ipSilateral side.
- just try this. It makes sense.
92
Timgren and Soinilla did a _____ to restore pelvic symmetry in patients with scoliosis?
What percent of imorovement at 6 months f/u?
Was their a correlation between length of case history and the outcome?
HVLAT or MET to the SIJ
88%
No correlation between length of case and outcome.
93
What did Hartman 2006 say regarding the SIJ positioning?
Forget the position, just manipulate it.
-Hartman, determining the position is too hard-man.
94
Mansilla-Ferragut et al. 2009 observed an increase of ____ mm mouth opening following a single L and R OA.
What are the 3 hypothesis that caused this increase?
3.5 mm
1. New OA position MODIFIED JAW POSITION
2. New OA position may FACILITATE mouth opening
3. Reflex inhibitin to the MASSETER muscle (trigeminocervical nucleus inputs causes a reflexive contraction in the masseter restricting motion)
95
What did Ernst and Canter in 2006 say regarding manipulation?
“Absense of evidence is not the same as evidence of absense of an effect. None of the systematic reviews demonstrate that SMT is ineffective.”
96
Bronfort et al. 2004, compared SMT and mobilization for acute and long term LBP and what was the conclusion?
SMT was better. Moderate evidence for SMT, strengthening exercises, prescription of NSAIDs, and exercise.
97
Cochrane review in 2010 reported what for neck pain?
Low quality evidence for SMT/Mobilizations
98
Lehman et al. 2001, what does HVLAT stimulate?
Gamma motor neurons, which reflexively stimulates alpha motor neurons via muscle spindles (hypertonicity).
Lehmanna (gamma gain).
99
Lund et al 2010, how can muscle spindles cause pain?
Muscle spindles contain pain receptors which can further stimulate gamma gain
100
Travell et al 1942, what increases the sensitivity of muscle spindles?
The accumulation of muscle metabolites excites GMN’s and reflexively increases sensitivity of muscle spindles, which then cause alpha motor neuron activitation and hypertonicity.
101
What did Shah et al. in 2008 notice about active MTrP’s?
They were significantly more acidic than latent, and latent were more acidic than normal muscle.
102
According to Indahl et al. 1997, what does a stretch of the facet capsule do?
It stimulates inhibitory interneurons, which decreases activity in the paraspinals
Indahl = inhibitory
103
Describe the Energy Crisis Hypothesis
Ach - compression - sensitizing substances.
1. Excessive release of Ach causes a sustained depolarization of muscle fibers.
2. The sustained contractions of muscle compresses local blood supply resulting in an energy crisis in the local region.
3. This crisis produces sensitizing substances which interact with nociceptive nerves which localizes pain within the muscle/NMJ.
104
What did Boal and Gillette demonstrate with rats?
Hyperalgesia is established by C-fiber activation of dorsal horns.
105
Bolton and Budgell 2006, noticed that manipulation and mobilizations stimulate which kind of muscles?
Manipulation - stimulates receptors within short and deep intervertebral muscles.
Mobilization - stimulates more superficial axial (multi-segmental muscles).
106
Beattie et al. 2013, observed that spinal manipulation does what to the disc?
Causes intervertebral disc diffusion.
(Beattie - beat old age with disc healing)
107
Colloca et al 2004 showed that spinal manipulation increases afferant discharge from the ___ ___ ___ ___ and quiets _____.
Increases: afferent discharge of mechanoreceptors from the disc, ligaments, muscles, and facets.
Quiets: the alpha motor neuron pool.
108
What did Indahl et al. in 1997 notice when he injected 1 mL of saline into the lumbar facets and e-stim to the annulus?
That there’s a connection between the lumbar facets, multifidus, and IVD.
It caused an immediate (<5 min) reduction in multifidus and longissimus EMG activity. Also, e-stim of the annulus of the disc elicits a reflex in these two muscles.
109
Summary: What are the reasons for applying a thrust?
1. To facilitate movement
2. Relieve pain
3. Increase circulation
4. Immediate neuro physiological reflex response
5. Immediate increase in strength
6. To release entrapment
7. Powerful psychological effect
8. Quicker than mobilizing
9. Correction of positional faults
110
What are the 4 ways that manipulation decrease pain?
ANSNP
1. Manipulation induced analgesia (MIA)
2. Non-opiod mechanisms
3. Serotonergic and nonadrenergic pathways
4. Stimulates dPAG - decreasing inhibition
111
How does manipulation increase circulation?
1. Sympathetic and parasympathetic effects on vasculature
2. Sympathoexcitatory response: decreases skin temperature and increases skin conductance
112
How does manipulation immediately cause muscle relaxation?
It immediatelty resets the muscle spindles.
113
What is the odds of worsening a LDH (lumbar disc herniation) with manipulation?
1/3.7M
114
What are the 3 absolute VASCULAR contraindications to HVLAT?
CAH
CAD, aortic aneurysm > 5cm, severe hemophilla
115
What are the BONE absolute contraindications to HVLAT?
Tumor, TB infection, metabolic (osteomalacia, congenital dysplasias, fracture, iatrogenic (long-term corticosteroid use), inflammatory (chronic RA), ankylosing spondylitis, upper cervical instability
116
What are the 3 NEUROLOGICAL absolute contraindications to HVLAT?
Cauda equina, cervical myelopathy, radiculopathy (but neurogenic pain is NOT an absolute contradiction).
117
What are the OTHER 3 absolute contraindications to HVLAT?
Excessive/Extreme pain
A lack of a clinical diagnosis
Lack of pt consent
118
What are the relative contraindications to HVLAT?
PPP
1. Disc herniation/prolapse (1:3.7M)
2. Pregnancy (No at 3-4 months), this is BSO guidelines, there’s no research showing a miscarriage
3. Osteoporosis, RA, Spondy (avoid extension), and advanced DJD
119
What 5 things do Ross and Cheeks recommend doing for testing upper cervical stability, ligament integrity, and fractures?
Sharp 40 CNX
1. Intermittent sharp pain just below the base of the skull, most noticeable with ROT
2. ROT < 40
3. C-spine rules
4. Neurological exam (sensation, strength, gait, bowel/bladder, UMN/LMN, DTR’s
5. Standard 3 view series of cervical A-P, lateral, and open-mouth views
120
What are the 3 x-ray images for upper cervical stability?
1. Cervical A-P
2. Lateral
3. Open-mouth views
121
What % of cervical fractures involve the odontoid in people > 65 y.o?
20%
122
What are the 3 types of odontoid fractures?
1. Oblique fx in the upper odontoid
2. Fracture at the base as it attaches to C2
3. Fracture line extends through the body of the axis
123
What is the sensitivity and specificity if the canadian c-spine rules? What are the rules?
Sensitivity: 100%
Specificity: 43%
1. > 65 y.o OR
2. Paresthesias in the extremities OR
3. Dangerous MOI (fall > 3 feet/5 stairs, MVA > 62 mph, axial load (diving injury), etc.
4. < 45 degrees of neck rotation in both directions without pain
Any present? = imaging.
- sixty five, drive fast, sense deprive
124
Is the transverse ligament test good?
It has not been validated
125
Is sharp purser test good? Sensitivity/specificity?
Yes.
Sensitivity: 69%
Specificity: 96%
Stabilize C2 and push the head back.
126
What is the tectorial membrane test?
Sensitivity?
Supine.
Pincer grasp C2
Distract cranium
> 2mm of movement is positive
Sensitivity: 70%
127
What are the 6 symptoms of craniOvertebral instability?
1. Occipital numbness
2. Neck-tongue syndrome
3. Headache with sustained neck flexion
4. Lump in throat with neck flexion
5. CN Testing
6. Cord Signs (Lhermitte's or Rhomberg's sign)
128
What is Lhermitte's sign?
What does it indicate?
An electrical sensation down the back and into the limbs produced by neck flexion or ext. It indicates a lesion of the DCML, caudal medulla, MS, or SC compression
129
What is Rhomberg's sign?
A neurological test to assess the DCML (which is essential for joint positional sense (JPS), proprioception, and vibration.
Eyes closed with arms out and pt loses balance.
130
Out of the DCML System, which tracts are the pyramidal and extrapyramidal tracts?
Pyramidal: Lateral and Anterior corticospinal tracts
Extrapyramidal: Instead of CCTV, it's RRTV
1. Rubrospinal tract
2. Reticulospinal tract
3. Tectospinal tract
4. Vestibulospinal tract
131
Out of the sensory and ascending (afferent) pathways, which are apart of the:
DCML:
Spinocerebellar:
Anterolateral system:
DCML: Gracile and Cuneate fasciculus
Spinocerebellar: Ant. and Post. Spinocerebellar
Anterolateral: Anterior and Lateral Spinothalamic tracts
132
Which tract does Hoffman's sign assess?
The corticospinal tract (flick the 3rd or 4th finger
133
What are the 3 main features to look for with an open mouth x-ray?
Is the C2 SP in midline? Indicates an alar ligament rupture
Are the peri-odontoid spaces equal?
Are the articular margins of C1-2 lined up?
- MOA
134
What % of chiropractors believe that diseases are caused by misalignments?
68%
135
What % of chiropractors believe in the vertebral subluxation complex without any research supporting this claim?
88%
136
Do chiropractors claim to treat all 10 organ systems?
yes
137
Do chiropractors sign death and birth certificates?
yes
138
Do chiropractors deliver babies or perform minor surgeries?
yes
139
What are some weird conditions that chiropractors claim to treat with SMT?
ADHD, ear infections, allergies, colic, and autism
140
Do chiropractors require even a bachelor's degree?
no
141
Do chiropractors believe the vertebral subluxation complex causes disease in organs?
yes
142
What is the most accurate way to diagnose and manage SIJ Dysfunction according to Laslett?
Fluoroscopy guided injection, followed by an anesthetic block - 80% pain relief.
143
What are the six Laslett Cluster tests?
How many tests needs to be positive?
What is the sensitivity and specificity?
1. posterior thigh thrust
2+3. Gaenslen's test on R L
4. ASIS Distraction
5. ASIS Compression
6. Sacral compression
3/6 positive
Sensitivity: 91%
Specificity: 87%
144
Van der Wurff et al. in 2006 created his own pain provocation tests (PPT), what is the difference between his tests and laslett's?
Wurff replaced the sacral compression with Patrick's sign (FABER's)
145
What is the inter-rater reliability of Van der Wurff's PPT's?
100%
146
Does Laslett and Van der Wurff claim that you need to rule out a disc first?
Laslett says you do.
Wurff says you don't.
147
What did Gutke et al. in 2009 discover when doing Laslett's cluster tests on patients?
That the PPT's were still negative in patients with a lumbar disc herniation. Thus, you do not need to rule out the disc.
148
Why did Berthelot et al. in 2006 say that SIJ blocks are unreliable for diagnosing SIJ pain?
unidentical, diffuses, ligaments
1. The effects of 2 consecutive SIJ blocks are identical in only 60% of cases.
2. The anesthetic diffuses out of the SIJ in 61% of cases and contacts the adjacent nerve trunks and cords, they are <10 mm away.
3. The pain patterns believe to come from the SIJ can be related to extra-articular surfaces, most notably the ligaments surround the SIJ.
149
Why are SIJ motion tests not reliable?
1. Poor inter-test reliability
2. Less than 50% sensitivity and specificity
3. <2 mm and <2 degrees of rotation
4. SIJ is 5-7 mm deep to the skin
5. There are 7 anatomical layers overlying the superior and middle aspects of the SIJ
150
What did Robinson et al. in 2007 say about SIJ palpation tests and joint play?
they have poor inter-examiner reliability
Robin is robbing the palpation tests
151
Which SI tests did Riddle and Freburger in 2002 determine had poor reliability for clinical use?
Standing flexion, prone knee flexion, supine to sit, and sitting PSIS tests
152
What did Hartman 2006 say about the SIJ
Forget the tests, just manipulate it.
- manipulating is an art
153
According to Van der Wurff et al. in 2006, what were the pain referral patterns of the SIJ
1. Pain in the buttock, posterior thigh, medial and lateral lower leg, and dorsimedial and dorsilateral sides of the foot
2. 100% felt pain in Fortin's area
3. 100% felt pain just inferolateral to Fortin's area, ischial tuberosity, and lateral thigh
4. The thigh, lower leg, and foot
154
How can the SIJ refer pain to the thigh, lower leg, and foot?
It is supplied ventrally by L3-S2 and dorsally by S1-S4
155
What did Mens et al. say regarding a pelvic belt?
Performing an ASLR with a pelvic belt improved in 20/21 pt's.
156
How many mm's of a step was observed in the pubic margins during an ASLR?
5 mm
157
If the R pubic bone is smaller than the L, which way is the nominate rotated?
The R is anteriorly rotated
158
What is the sensitivity and specificity of an ASLR while palpating the pubic bones?
87% sensitivity
94% specificity
159
What are the 4 best clinical diagnosis tests for SIJ?
1. Laslett's cluster 3/6
2. Fortin's Area
3. ASLR
4. Trigger points (piriformis BL-54 and QL BL-23
160
What did Mens et al. in 2000 say regarding the lumbopelvic stabilization?
25% of the experimental group (force closure group) had to cease exercises due to increases in pain.
Men can deal with pain (not really)
161
What did Nilsson-Wikmar et al. and Dumas in 1998/1995 say regarding exercises for the SIJ?
It's not effective.
162
Hungerford et. al in 2003 found a delay in which 3 lumbopelvic muscles when there's pain?
Internal Oblique
Lumbar Multifidus
Glute max
163
What did Almeida et al. in 2010 find regarding HVLAT to the SIJ?
HVLAT can alter the tone of the pelvic floor (perineal muscles) and improve stress urinary incontinence, pelvic pain, etc.
164
Did Stuge et al. in 2006 recommend manipulating the SIJ before or after exercise?
before
165
What are the 5 goals of HVLAT to the SIJ?
1. Decrease pain
2. Increase ROM
3. Increase muscle strength (force closure)
4. Improve feed forward activation times
5. Put it back in place (maybe, Cibulka found changes in the innominate, and Child found iliac crests even, but Tullberg found no change in the SIJ)
166
According to Childs et al. in 2007 is exercise beneficial for the SIJ?
How much better or worse was the ex group?
No. The exercise group was 8x worse.
167
Why do we get an immediate hypoalgesia response from manipulating the SIJ?
1. Descending inhibitory mechanisms (dPAG)
2. Non-opioid mechanisms
3. Possibly from immediate form-closure improvement - Stuge et. al
168
To date, are there any "empirical" evidence that supports the use of specific or global "stabilization" exercises for SIJ pain?
No.
169
To date, is there evidence that supports the use of mobilization or manipulation in pt's diagnosed with SIJ?
1 cohort study exists - Shearar et al. 2005
170
To date, is there any evidence that treating a specific positional fault of the sacrum gives better outcomes than simply just manipulating it?
No.
171
What did Moset et. al observe when he tested HVLAT's effects on the hemodynamics of the VA?
Maximal neck rotation:
Maximal neck rotation+HVLAT:
Changes in cerebral hemodynamics:
Functional connectivity in the posterior cerebrum and cerebellum (MRI):
Maximal neck rotation: changes in blood flow
Maximal neck rotation+HVLAT: also changes in blood flow
Changes in cerebral hemodynamics: No changes.
Functional connectivity in the posterior cerebrum and cerebellum (MRI): significant increases with both tests.
172
What did Kranenburg et al. find with head and neck positions on the VA, ICA's, and Intracranial Arteries?
"It may not alter blood flow as much as previously expected.
172
What did Ian et al. observe from one sessions of manipulating the t-spine in patients with C-RAD?
1. Improvements in pain, disability, and ROM
2. Improved deep neck flexor endurance
These effects lasted for 48-72 hours
172
What did Raymond Butts et al. observe from a literature review for TMD
1. Limited support for strengthening exercises and soft tissue targeting the muscles of mastication.
2. Limited evidence for splinting and electrophysical modalities (laser, ultrasound, TENS, and iontophoresis)
3. Manipulation to the TMJ or upper-cervical were generally supported.
4. DN/Acupuncture to the lateral pterygoid and posterior periarticular connective tissue led to significant improvements in pain and disability
173
Raymond Butts concluded from a literature review that the best areas to impact for TMD are:
1. Joint capsule
2. Articular disc and muscles of mastication (mostly the superior and inferior head of the lateral pterygoid)
174
Dunning et al. found that manipulation was superior to mobilization in patients with CH based on what criteria?
Significantly greater reductions in headache intensity, disability, frequency, and shorter duration at 3 months.
175
Dunning et al. found manipulation superior to mobilization in patients with mechanical neck pain in the short- or long-term?
short-term
176
What did Keating et al. say regarding the chiropractor subluxation theory in 2005?
It stands pretty much where it did in the 20th century, an interesting notion without validation.
177
Mirtz et al. in 2009 did a literature review of the subluxation theory and found what?
There's no evidence of anything.
178
T or F: DeBoer and Hansen 1993, and Henderson et al. in 2007 both failed to isolate the subluxation as a quantifiable lesion.
True
179
What % of Canadian chiropractors still believe most diseases are caused by spinal misalignments (2002)?
68%
180
According to McDonald et al. in 2004, what percent of chiropractors still retain the term vertebral subluxation?
What percent still believe the subluxation is a significant contributor to 50% or more visceral disorders?
88%
75%
181
How many different types of headaches are there recognized by the IHS?
14 types, CGH is one of them
182
According to the IHS, what are the 5 symptoms of CGH?
Neck movements, posture, unilateral
1. Pain localized to the neck and occipital region.
2. Pain is aggravated by neck movements.
3. Sustained posture
4. Side dominant (may refer to the forehead)
5. Orbital, temples, ears
183
What are the 4 diagnostic criteria recognized by the IHS for CGH?
They must have at least one of the following: ROM, tone, radiological, tender (1RR-TT)
1. Resistance/limited neck PROM
2. Changes in neck muscle contour, texture, and tone.
3. Abnormal neck tenderness
4. Radiological exam reveals at least one of the following (movement abnormality with flexion/ext, abnormal posture, or fracture, congenital abnormalities, bone tumors, etc.)
184
Sjaastad et al. in 1998 mentioned these 4 symptoms as CGH?
1. Unilateral head pain
2. Without side shift
3. Neck pain (with movement and palpation)
4. Limited cervical ROM
US-PC gives you a headache
185
What is the cervicogenic prevalence rate?
4.1%
186
T or F: Cervicogenic headache is 1 of the 3 most common recurrent headaches?
True
187
What are the most common CGH Symptoms, and by how much?
100%: Unilateral, mechanical precipitation, diffuse arm discomfort.
97%: Posterior onset
93%: Restricted ROM
Other symptoms:
1. increased sedentary lifestyle
2. No affect from migraine meds
3. Nausea, phono/photophobia, dizziness, blurred vision, difficulty swallowing, and periocular edema
188
What are the 2 main vascular issues causing CGH?
1. Greater Occipital and Lesser Nerves
2. The Greater Auricular Branch of the Facial and Vagus Nerves
189
What are the four parts of the Trigeminocervical Nucleus?
TriegmmmMMSA
1. Mesencephalic nucleus
2. Main sensory nucleus
3. Spinal nucleus (contains branches to the maxillary and mandibular branches)
4. Additional afferents from Facial, Vagus, and Glossopharyngeal (ear and throat)
190
What does the Mesencephalic nucleus sense?
proprioception
Mesence-proprioception
191
What does the main sensory nucleus sense?
Sense the TPs
touch and pressure
192
What does the spinal nucleus sense?
pain and temperature (contains branches to the maxillary and mandibular branches)
Spinal - PT
193
T or F: Migraine is the 19th leading cause of years lived with disability
True
194
What % of people have migraines?
12%
195
What age group mostly has migraines?
Ages 12-40
196
IHS classification for Migraine Headaches WITHOUT AURA
UP? Na. uni, pulsating, nausea, avoid physical activity
At least 5 attacks fulfilling the below criteria:
1. Attacks lasting 4-72 hours
2. Headaches has at least two of the following:
- unilateral location
- PULSATING quality
- moderate-severe pain intensity
- aggravation or avoiding physical activity
- during headache at least one of the following (nausea/vomiting, photo- and phonophobia, not attributed to any other cause)
197
IHS classification for Migraine Headaches WITH AURA
At least one of the following: speech, visual, sensory
1. Fully reversible visual symptoms including positive features (flickering lights, spots or lines, and/or negative features of loss of vision
2. Fully reversible sensory symptoms including pins and needles and/or numbness
3. Fully reversible dysphasic speech disturbance
198
Describe the process of the trigeminocervical nucleus causing the CGH:
1. The migraine begins with cortical spreading hyperactivity followed by a depression
2. The hyperexcitability, then depression causes an increase then decrease in blood flow and subsequent release of NO and glutamate (hyperexcitability is connected with the aura)
3. NO and glutamate trigger a pain response in the trigeminocervical nucleus via calcitonin gene related peptide
199
IHS classification of Tension Type Headaches (TTH):
How many days?
Symptoms?
Tension - Twelve BPNN, bilateral, pulsating, not aggravated by PT, nausea
More than 10 episodes occurring less than 1 day per month, or on average, less than 12 days/yr and fulfilling the criteria of:
1. Headache lasting 30 mins to 7 days.
2. Headache has at least 2 of the following:
- BILATERAL location (frontal-occipital
- pressing/tightening (NON-PULSATING)
- mild or moderate intensity
- NOT aggravated by routine physical activity
- both of the following: No nausea/vomiting, or no more than 1 episode of photophobia or phonophobia
- not attributed to any other disorder
200
What is the most common type of recurring headache?
TTH
201
What population is TTH the most common in:
Men vs. Women?
Older or Younger than 50 y.o?
4:1 women
Young adults < 50 y.o
202
What manual tests are specifically accurate for diagnosing CGH?
Lateral glide testing - Fernandez de las Penas claims it's as good as a radiological examination for C3-7
Flexion Rotation Test - the greater restriction, the more severe the headache
203
What is the inter-rater agreement of the lateral glide test for C0-C3?
70% Jul et al. 1997
204
What is the sensitivity and specificity of the Flexion/ROT test for CGH?
Positive likelihood ratio?
Negative likelihood ratio?
91% Sensitivity
91% Specificity
10.65 positive likelihood ratio
0.095 negative likelihood ratio
205
According to Hall et al., what is a positive Flexion-Rotation Test, and which headache does it indiciate?
1. > 10 degree restriction indicates a positive test
2. < 30 degrees of rotation
CGH
206
What is the diagnostic accuracy of flexion-rotation test?
85% for CGH
207
According to Toby et al., Can the Flexion Rotation Test (FRT), be used to diagnose lower c-spine facet pain vs. CGH?
Specificity?
Yes, 92% specificity and 9.4 positive likelihood ratio.
They should have a lot of ROM with reproduction of pain.
208
According to Jul et al. in 1999, what is the normal criteria for the craniocervical flexion test?
mmHg?
duration?
repetitions?
26-28 mmHg
10 second holds
10 repetitions
209
According to Olson et al. in 2006 what is the normal height and duration for the Neck Flexion Endurance Test?
2 cm (2 fingers off the table)
Males: 25 seconds
Females: 20 seconds
210
According to Deborah Falla et al., does training the cervical muscles with prescribed motor tasks change the muscle activation during a functional activity?
No.
Low-intensity flexor endurance, or high-intensity did not change it.
211
According to Gemma et al., What is the best practice for reducing pain and improving cervical motion in pt's with TTH?
MT + HVLAT
212
Is manipulation or MT better for CGH?
Manipulation - Bronfort 2001
213
The Cochrane Review of 2005 recommended what treatment for CGH and migraines?
SMT + low-intensity endurance training for CGH
SMT has a similar affect as amitriptyline for migraines
214
According to Jull et al. in 2002, what % of patients diagnosed with CGH will respond to SMT and/or exercise?
76%
215
What four criteria should we look for if we could improve a patient's headache according to Niere in 1998?
Frequency, affective, uni, diet
FrAUD
1. Low frequency headaches
2. Affective and autonomic pain descriptors
3. Unilateral headaches
4. Dietary aggravators suggestive of poor outcomes
216
With headaches, what 3 criteria were NOT suggestive of poor outcomes from PT?
Age intensitt chronic
AIC
Age
High Intensity
Chronicity
217
Niere 1997: Is headache frequency, intensity, or duration the best indicator of treatment effect?
Headache FREQUENCY is the most valuable rather than intensity or duration
218
According to Dunning et al., How much better was the cervical and upper thoracic group vs. non-thrust in pt's with CGH headache?
4.6x more likely to achieve 50% or more improvement in headache intensity at 3 months.
Cervical-Upper Thoracic (CUT 46WC)
219
According to Dunning et al., How much reduction in disability did the manipulation vs. mobilization CGH groups improve?
65.7% vs. 30.1%
Thus, 9.6x more likely to obtain 50% reduction in disability at 3 months
220
Dunning: At 3 months, the HVLAT group was taking how much less medication vs. mobilizations in pt's with CGH?
56.9% vs. 25%
4x more likely to completely stop taking medicine
221
What % of patients with CGH had a successful outcome with manipulation?
89.7%
222
T or F: Dunning: Pt's receiving HVLAT were 5x more likely than non-thrust mobilization and exercise to experience no headaches or less than 5 hours of headaches per week at 3 months follow-up
True
223
What did Boyle et al. in 1999 conclude about shoulder impingement or a RTC tear?
It's likely a 2nd rib sprain, strain, or subluxation
224
What did Boyle et al. in 1999 say needs to be included in the assessment of acute/chronic shoulder pain?
palpation of the 2nd rib
225
According to Boyle et al., in 1999, what may indicate 2nd rib dysfunction?
increased tone of the posterior scalene
226
What are the common clinical manifestations of rib dysfunction?
- Shoulder pain (A-P and central)
- Referred pain to the anterior upper arm
- Limited ROM
- Shoulder ABD limited by pain
- (+) Hawkin's Kennedy
- Levator scapulae and scalene muscles in spasm
- 2 cortisone injections giving short term relief
- C6/7 hypomobile and tender
- P/A motion of 2nd rib is extremely painful and hypomobile
- RTC muscles are weak and painful likely from pain inhibition
227
What are the 2 possibly MOI's to 2nd rib dysfunction?
1. Direct violence to the rib or acute spasm of the POSTERIOR SCALENE
2. Insidious onset from habitual over-activity of the POSTERIOR SCALENE resulting in chronic superior and anterior subluxation of the 2nd rib at the vertebral articulation
228
Beattie et al. in 2013 observed that HVLAT increased what?
IVD diffusion
229
Who invented the myth of core stability?
Eyal Lederman 2008
Aye-yall this ain’t true
230
Has any study to date demonstrated that LBP is due to spinal instability?
No.
231
What is the real reason for chronic LBP?
There's a delay in motor activation control (motor control impairment syndrome)
232
Who started lumbar spine instability (LSI)?
Richardson 1990s
Rich thought he’d get rich off this idea.
233
Why was Richardson's research for LSI so bad?
He tried to sense deep musculature with surface level EMG
234
When you stand is the TrA active?
No. You need to PPT to activate the TrA, when you stand you're in APT.
235
Has any study to date shown a positive effect on muscle activation in the low back?
No.
236
McGill 2010: Why is there a delay in muscle activation in the low back?
Pain-inhibition response from your spine delays muscle activation
237
Why does the CNS cause a delay in muscle activation in the low back?
Reflex inhibition due to joint effusion (similar concept of quadriceps swelling)
238
Why is there no effect from TrA training?
It's not high enough intensity
239
What did Hong 2006 say regarding reducing LBP efficiently?
Treating the facet is more effective than treating the periphery
- Hong, hong treat the facet
240
What is the recurrence rate of LBP in pt's who performed lumbar multifidus strengthening vs. not?
30% vs. 80%
241
Does a T3-4 change the pupil diameter? Sillevis et al 2010
No
242
Cross et al., Is there strong or weak evidence supporting the use of T-Spine HVLAT for short-term benefits in pt's with acute or subacute mechanical neck pain?
It's weak evidence because of a limited number of RCTs
243
Dunning: how much less disability and pain in the manipulation group vs. mobilization for cervical?
50.5% less disability
58.5% less pain
244
Dunning: how much more cervical RROT was improved vs. LROT?
RROT: 8.4 degrees
LROT: 5.9 degrees
245
Dunning: How much did the deep neck flexor strength improve?
3.4 mmHg
246
Was their a change in LM thickness following SMT? Koppenhaver et al. 2011
Immediately no, but after 3-4 days yes, but it did not last more than a week
247
According to Hancock et al. 2007, what was the prevalence of each of structure as being the source of LBP:
Disc:
Facet Joint:
SIJ:
Disc: 39% (range of 20-79%)
Facet: 15% (range of 12-61%)
SIJ: 13% (range of 28-61%)
248
Is there currently a universal gold standard for the diagnosis of LBP?
No
249
What 3 features on an MRI are informative (+LR >2) as indicating the disc as the source of their LBP?
HDEee
1. High intensity zone
2. End-plate changes
3. Disc Degeneration
250
What was the only clinical feature that increases the likelihood as the disc being the source of their LBP? (+LR 2.8)
Centralization
251
What was the only test to reduce the likelihood as the disc being the source of their pain radiologically? 5x more likely to not have the disc as the pain generator
Absence of disc degeneration on an MRI
252
What is Revel's Criteria?
Need 5/7 clinical characteristics for facet joint pain:
1. > 65 y.o
2. Pain relieved by recumbent posture
3,4,5. No pain exacerbation with coughing, forward flexion, or with rising from sitting (RCF)
6. Pain with hyperextension
7. Pain with extension and rotation
REvels
Recumbent
RCF - Rising, Coughing, Flexion
Extension + ROT
Hyperextension
253
What is the sensitivity and specificity of Revel's Criteria?
85% sensitivity
89% specificity
254
What is the positive and negative LR of multiple SIJ tests?
+3.2
-0.29
255
Hancock et al. 2007: Conclusion #1:
Are their clinical tests to both increase AND decrease the likelihood of the disc as the source of LBP?
No.
256
Hancock et al. 2007: Conclusion #1:
Does the MRI high intensity zone, disc degeneration, end-plate changes, and centralization have informative +LR's?
Yes
257
Hancock et al. 2007: Conclusion #1:
Are their good diagnostic tests for the facet joint that appears informative?
No. However, their are great tests to predict the disc and SIJ
258
Hancock et al. 2007: Conclusion #2:
For the studies investigating the facet joint as the source of the patient's symptoms, have good validity?
No, the tests have limited or no diagnostic validity
259
Hancock et al. 2007: Conclusion #3:
Is there research indicating the knowledge of the source of LBP leads to improved outcomes?
Currently their is not easily available methods to identify the source of LBP.
260
What did Lim et al. 2011 find regarding reducing LBP?
Pilates is more effective than other exercises
261
Child et al., Did the LBP CPR perform well at identifying patients with acute, non-specific LBP who were most likely to respond to SMT?
No, it's no better than chance
262
What is the CPR for LBP?
16, 19, hip, knee, back
<16 days duration of current episode
No sx distal to the knee
FABQ < 19
At least 1 hypomobile lumbar segment on PA testing
> 35 degrees of hip IR
263
Are there any reliable tests to diagnose LSI? O'Sullivan 2006
No
264
According to Hayes et al. in 1989, ______% of asymptomatic patients had at least 1 lumbar segment exceeding the instability threshold on flexion/extension radiographs of the lumbar spine. Thus, there's a high false-positive
42%
265
What does Delitto et al. 1995 BELIEVE as the confirmatory data for LSI?
DeLOST-FB
1. Lateral shift deformity
2. Use of Oral contraceptives
3. Short-term relief from manipulation
4. Hx of trauma
5. Frequent recurrences of LBP
6. Improved symptoms with the use of a Brace
266
Which two famous therapist's mentioned the "step-off" between the SP's?
Paris 1985 and Maitland 1986
267
What 3 characteristics did O'Sullivan in 2000 describe as the signs as LSI?
1. Giving way, slipping out, or locking
2. Instability catch
3. Aberrant motions (However, studies have shown aberrant movements to be normal in some imaging studies)
O'GIA
268
Is the prone instability test valid?
No.
- add compression while they raise legs to see if it reduces LBP
269
3 Other Findings for LSI form the LSI Convention:
1. Pain immediately upon sitting, and relieved in standing - Paris and Maigne
2. Painful arc through the ROM and uses hands to stand up - Kirkaldy-Willis and Farfan 1982, O'Sullivan 2000
3. Increased global muscular tone - Panjabi 1992, Cook et al. 2006
Met SAM at the convention
Sitting
Arc
Muscle tone
270
Is the posterior shear test valid? Delitto et al. 1995
No
- Produce a posterior force through the pt’s abdomen and anterior force with opposite hand through pelvis (in standing). Test repeated at all lumbar levels
271
Objective indicators for LSI according to Paris 1985, 2003:
1. Instability catch
2. Hypertrophied band horizontally, raised muscle tone in standing
3. Step-off on standing that disappears in lying
4. Shaking/Juddering on FB
5. Imbalance on single leg standing
6. Grade 5 or 6 PIVM
- instability, hypertrophied, step-off, juddering, imbalance, grade 5
IHSJIG
272
Spine instability is best classified into which two categories?
1. Radiological appreciable instability - marked disruption of passive Osseo-ligamentous constraints.
2. Clinical instability - more subtle and challenging to diagnose. It involves the NM system with inconsistent findings during traditional radiographic analysis
273
When is a lumbar fusion used? Sonntag and Marciano
1. > 4 mm of translation or 10 degrees of rotation
2. AND they have failed conservative treatment
274
Delphi Study: What are the 3 subjective indicators of LSI
GF's
1. Giving way
2. Self-manipulator
3. Frequent episodes of symptoms
275
Delphi Study: What are the 3 objective indicators of LSI
1. Poor lumbopelvic control
2. poor coordination/NM control including juddering/shaking
3. Decreased strength and endurance of local muscles at the level of segmental instability
276
Cook and Hegedus 2011:
T or F: The lateral glide test for C2-3 was found as an effective diagnostic test
True
277
Cook and Hegedus 2011:
T or F: The PA's and Spurling's tests were effective only as screening tools, but NOT FOR DIAGNOSIS
TRUE
278
Cook and Hegedus 2011:
Which 3 lumbar tests are useful for diagnosis?
- Centralization, PAIVMS, Percussion, Supine
Laslett 2005: centralization for discogenic pain.
Fritz et al 2005: Lumbar PAIVMs and PPIVMs diagnostic for radiological instability
Percussion and supine sign diagnostic for compression fracture
279
What test was good for SCREENING ZJ pain?
ER test
280
What test was good for SCREENING nerve root compression?
SLR test
281
Conclusions for LBP
1. Most clinicians do not make clinical decisions based on a single test finding
2. Clusters provide more promising findings and assist clinical decision making
3. Stand alone tests only provide marginal value
282
Alqami et al. 2011: Determined that the passive lumbar extension test may be useful for diagnosing a structural LSI based on what sensitivity, specificity, and +LR?
84% sensitivity
90% specificity
8.8 +LR
283
Hicks et al 2005: Is it possible to accurately diagnose LSI?
No, there's no true reference standard so Flynn et al. made a CPR for stabilization exercises
284
What is Flynn et al CPR for manipulation (only the Chicago SI Technique)?
3/5 positive = x%?
Duration of sx < 16 days
FABQ < 19
Lumbar hypomobility on spring test
At least one hip > 35 degrees IR
No symptoms distal to the knee
4/5: 49-95% probable success with manipulation
3/5: 68%
285
What % of patients had a successful lumbar manipulation without any attempt at prediction?
45%
286
What was the single best predictor of success with manipulation?
duration of sx < 16 because it's basically an acute pt
287
What % of success did Cleland et al in 2006 have with the lateral recumbent lumbar roll HVLAT using 4/5 Flynn's criteria?
92%
288
Are manual therapy techniques specific?
Not really.
Lee et al. 2005: PA to C3 moved everything from occiput to T3. PA at L3 moved T10-sacrum
289
Beffa and Matthews 2004: Manipulations targeted at the L5 vertebrae cavitated which segment?
Cavitated L3/4 more than 50% of the time
290
Ross et al 2004: What % of manipulation techniques in the lumbar spine were found to accurately produce clicks at the targeted vertebrae?
46%
291
What was Cleland et al.'s conclusion in 2006 regarding if manual therapy is specific or not?
Manipulation are not as specific as we think, thus the choice of one technique over the other may be less important than previously thought
292
According to Chiradejnant and Haas on NS-LBP, are specific or random mobilizations better?
There's no difference in specific vs. not specific (of course, you did a non specific LBP)
293
Bjorkman 1999: With NSAIDs, Adverse events occur in _% of patients and significant complications occur in _% of patients
Adverse: 25%
Significant complications: 1-4%
294
Graumlich 2001: GI complications due to NSAIDs cause more than ______ hospitalizations and an estimated _____ deaths each year
100,000 complications
16,500 deaths
295
Henriques et al. 2001 and Kardaun et al. 1990: What is the chances of cauda equina syndrome (CES) following lumbar surgery?
Any complication rate?
Mortality rate?
CES: 0.2-1% of patients
Complication rate: 3.7%
Mortality rate: 1.5%
296
Have NSAIDs or surgery been proven to be more effective in the tx of LDH than spinal manipulation?
No - Oliphant 2004
297
Fritz et al. 2005: What was the chance of a successful outcome with manipulation on hypomobile and hypermobile patients?
Hypomobile: 74% successful outcome
Hypermobile: 17% successful. 22% for stabilization
298
What was Bronfort's 4 main conclusions regarding acute LBP and HVLAT?
1. HVLAT > mobilizations and detuned diathermy for short-term
2. HVLAT+Exercise > NSAIDs for short- and long-term relief
3. SMT/MOB > HEP
4. SMT/MOB > general practice and PT
299
What were the 3 main findings from the UK Beam Trial?
SMT over a 12 week period produced benefits relative to best care in general medical practice at both 3 and 12 months
SMT is cost-effective
Manipulation ALONE is > Manipulation and exercise
300
What did Giles and Mutler in 2003 find for chronic spinal pain?
short-term HVLAT > acupuncture or medication
GM
Grade V > Medication
301
Herzog et al. 1991: Was there a difference between SMT, back education, and exercise in pain and disability?
There's no significant difference in the short-term.
302
Rubenstein et al 2011 Cochrane Review: T or F: SMT is effective as other physiotherapy techniques
True
303
What was the problem with Richardson's studies in 1990, 1992, 1999, and 2000?
They never measured the TrA or LM, and thus, never measured spinal stability
The authors conclusions did not support the study results
304
What did MacDonald in 2007 find regarding the TrA and deep multifidus?
There's no evidence that the TrA and deep multifidus co-contract for spinal stability
The SM and ES may equally contribute to lumbar stability
305
What did Hodges and Richardson find in 1996 regarding TrA muscle activation?
There was a significant DELAY between 50-450 MS in the onset of contraction of TrA
In asymptomatic patients the TrA preceded by a mean of 110ms
306
How does reflex inhibition (RI) cause a muscular delay?
RI produces a decreased activation level of the alpha motor neuron at the ventral horn. RI is linked to joint effusion, pain, ligament stretch, and capsular compression. Thus, the alpha motor neuron is pool is less excitable.
307
What did Costa et al. in 2009 say regarding the use of ultrasound measurements?
There's multiple sources of error. Thus, no studies evaluated the reproducibility of the difference in thickness change over time.
308
Stevens et al. 2006: You need a _% MVC to promote strength trunk gains (likely not being achieved with breathing, tilting, or drawing in manuevers.
70%
309
Brown and McGill et al 2006: Found that co-contracting specific muscles could be ___ and ___ spine stability
Dangerous and decrease
310
Vera-garcia 2006: Found that abdominal hollowing and bracing were of the ___ stabilization maneuvers
worst
311
Cholewicki et al. 2002: T or F: You cannot contract the TrA alone
True
312
Helewa et al 1999: Did strengthening of the abdominals prevent LBP?
No.
Hallaluah, someone is saying it’s not the core
313
Nadler 2002: Did strengthening the core decrease the occurrence of LBP?
No
314
Cairnes et al. 2006: Was there a difference in specific exercise vs. general exercise for LBP?
No difference
Cairnes doesn’t care what exercise you do.
315
Core stability assumptions:
Basically that a strong core reduces back pain
316
Fast et al 1990: Is there a correlation between sit-up performance and LBP?
No correlation
317
Leboeuf-Yde 2000: Is weight gain and obesity associated with LBP?
There's a very weak association
318
Lederman 2007: Can you correct TrA onset timing with exercise?
There's no study to date that demonstrates exercise can alter TrA timing
319
Marshall and Murphy 2006: There's a _% improvement in onset timing immediately following SIJ HVLAT?
28%
320
What is the one study that shows that strengthening the abdominals can reduce LBP and in which population?
- SS
O'Sullivan et al in 1997 in Spondylolysis/listhesis patients only.
321
Silfies et al. 2007: Do impairments in trunk position sense predispose athletes to future LBP injuries?
No
322
What's the summary on exercise for LBP?
Neither general or specific exercises are more effective in the management of LBP. However, there's research for training the multifidus in ACUTE and SUBACUTE only.
323
What did Hides et al. in 1994 find in patients with LBP vs. asymptomatic patients?
Marked side-to-side asymmetry of the CSA (cross-sectional area) of the LM. The atrophy was ipsilaterally on the symptomatic side
- Hides was hiding fat
324
Which lumbar segment had the greatest atrophy at the LM CSA?
L5
Multi-fidus
5-5
325
How long of an exercise program did it take to see a change in the LM CSA?
After 4-weeks the LM CSA improved by 0.7%
326
What % of subjects from the LM group suffered recurrences of LBP?
30%, while the control group reinjured at a much higher rate of 80%
327
Kader et al. looked at the LM and graded the amount of atrophy, what % of patients with LBP and LM atrophy?
80%
328
Which lumbar disc segment most commonly had degeneration?
L4/5, followed by L5/S1
329
What is the Lumbar Dorsal Ramus Syndrome?
LBP with referred leg pain induced by irritation to structures innervated by the dorsal ramus nerve triggers a self-sustained vicious cycle of myofascial pain, spasm, and ischemia that promotes LM muscle atrophy
330
What does the Dorsal Ramus Nerve Innervate (Medial Branch of Posterior Primary Ramus)?
1. Facet Joints
2. LM Muscle
3. Interspinous ligament
M1ZIMP
331
What is the best way to train the multifidus? Danneels et al. 2001:
Static isometric holding for 5 seconds between the concentric and eccentric phase was found to be critical in inducing muscle hypertrophy during the 10 weeks of training.
70% MVC REQUIRED
332
What exercise displayed the largest T2 increase in multifidus, followed by the ES (LT and IL), and finally the QL.
Dynamic Roman Chair trunk extension with 50-70% intensities (there was no difference between the 50-70% intensities).
333
Did Danneels et al. find a more increase in LM CSA in general exercise vs. stabilization exercises?
general exercise. The stabilization breathing sht doesn't work
334
What did Skyba hypothesize as giving pain relief from joint mobilization?
A descending inhibitory mechanism that utilizes serotonin and noradrenaline
-sky is all about the descent
335
What did Paungali et al 2004 suggest as the immediate hypoalgesia associated with MWM?
A non-opioid mechanism
336
What did Wright 1995 suggest gives the initial pain relief of MT?
Involves descending pain inhibitory systems projections from the dPAG to SC
- wright was right about descending pain
337
Bolton and Budgell believe there's a different impact on receptors from manipulation and mobilization, what's the difference?
Manipulation stimulates receptors within deep intervertebral muscles, while mobilization affects more superficial axial muscles
338
What did Katavich 1998 say SMT stimulates?
SMT stimulates neurophysiological pathways to inhibit pain and muscle responses
Indahl katavichh
339
What did Colloca et al 2004: SMT ___ afferent discharge of mechanoreceptors from disc, ligaments, muscles, and facets.
Increases
340
Hodges and Moseley 2003: Experimentally induced muscle pain studies strongly support the notion that pain may be the cause of the changes in ___ ___ in LBP
motor control
- moseley - motor control
341
Matre et al 1998: Observed that acute experimental pain caused changes in?
Spinal motoneuron activity
MAtre - Motorneuron Activity
342
What may be responsible for the changes in the TrA and LM delayed activation?
Fear and pain
343
Holm et al 2002, caused swelling by injecting lidocaine into the facet capsule and what was the result?
It decreased MUAPs of multifidus within 30s, but on average within 5 minutes after.
344
Capra and Ro in 2000 did an intramuscular injection with an algesic substance (causing muscle pain) and noticed a ____ in proprioceptive signals from the jaw muscles
decrease
345
Matre et al 1998: suggested a ___ sensitivity of the muscle spindles during muscle pain.
Increased
346
What did Arendnt-Nielsen et al 1995 observe regarding motor performance?
This was the first study to show that MSK pain can change the motor performance of the paraspinals during gait. It represents a direct interaction between NOCICEPTIVE AFFERENTS and motor neuron pool excitability, that could be mediated by a spinal reflex pathway.
347
Laslett et al 2006: did intra-articular injections into the ZJ, or medial branch blocks to diagnose ZJ mediated LBP. What % of patients responded to the ZJ blocks?
36% of all CLBP pt's responded to the ZJ blocks
348
What did Laslett say is an indicator for ZJ mediated pain?
spinal midline pain and/or the centralization phenomenon effectively rules out the ZJ
349
Young et al. 2003: T or F: Said that patients experiencing centralization did NOT respond to ZJ blocks.
True
350
Laslett in 2005: Has centralization been found to be highly specific or sensitive for pain provocation during discography?
Specific
351
Wilde et al 2007: Is there a valid and reliable way to diagnose lumbar ZJ's as the source of LBP?
Nope
352
Wilde et al 2007: Is the clinical feature of extension, lateral flexion, and rotation validated to diagnose Lumbar ZJ pain?
Nope
353
What are the highest indicators of Lumbar ZJ pain?
1. 94% - Localized unilateral LBP
2. 89% - Worse with unilateral pressure
3. 89% - Lack of radicular features
4. 78% - Pain eased by flexion
5. 72% - If there's referred pain, it does not pass the knee
354
According to Legaspi and Edmond in 2007, is coupled motion of the lumbar spine evidenced-based?
No.
355
Lee and Elliot 2008: What are the findings for Myelopathy?
1. UE and LE hyperreflexia bilaterally.
2. Sometimes, Lhermitte's sign aka the Barber Chair Phenomenon
3. Rhomberg's sign
4. Hoffman's sign
356
According to Dan and Saccasan in 1983, is a lumbar HVLAT without potential risk?
No. There's 7 serious complications
357
Santilli et al. SMT for acute LBP with disc protrusion resulted in ___% of pt's being pain-free, and a relief of radiating pain into the legs for ___% of pt's.
28% pain-free
55% no radicular sx
358
According to Laslett in 2003 and 2005, what is the gold-standard for pain-relief? It led to an 80% pain relief.
Fluoroscopy guided injection with anesthetic block
359
According to Laslett, if all 6 SIJ provocation tests do not provoke the familiar pain...
The SIJ is not the source of the back pain
360
Berthelot et al. 2006: ___% of anesthetic diffuses out of the SIJ and often hits the adjacent nerve root
61%
361
Van der Wurff's Sensitivity and Specificity?
x/5 tests positive?
3/5 positive
85% sensitivity
79% specificity
Replace sacral compression with FABERs
362
Riddle and Freburger 2002: Is it possible the determine which position the sacrum is stuck in?
No.
363
Peace and Fryer 2004: Is there a correlation between bony asymmetry and LBP?
No
364
Mens et al. do SIJ stabilization or diagonal trunk training (IO, EO, LM, GMax, Lats) exercises help?
no
365
Nilsson-Wikmar et al. is there a difference between in-clinic or at home PT (SIJ)?
No
366
Dumas et al. 1995: Did exercise have an effect on the prevention or treatment of pelvic pain during or after childbirth?
no
367
O'Sullivan 1997: Does specific training focusing on the TrA or LM help individuals with spondy?
Yes
368
Hides et al 1996, 2001: is lumbar multifidus training supported in the acute 1st STAGE ONLY
Yes
369
Pool-Goudzwaard et al 2004, observed that pelvic floor muscles ___ the pelvic ring
stiffen
370
Cervical Radiculopathy Test
1. Spurling's test- median N.
2. Cervical distraction, rotation - symptomatic side < 60 degrees
3. NDI > 10/50
4. 18-65 yo
Spurs scored 60 and the nets scored 10, 18-65 yo
371
Does Laslett find manipulation to be effective in treating SIJ pain?
Instead, what does Laslett find to be effective in the management of SIJ pain?
No
Corticosteroid injections, phenol injections, and radiofrequency neurotomy. Also surgical debridement and fusion have a moderate chance of pain reduction
372
To date, is there evidence that supports the use of specific or global stabilization exercises in those patients diagnosed with SIJD
No
373
Are SIJ symmery and motion tests reliable?
no
374
What is the best-practice for SIJ diagnosis?
Multi-test regimen of pain provocation tests and Forton's area
375
Is there any evidence supporting the use of mobilization or HVLAT for SIJD?
No
376
Is there any evidence directly addressing whether manipulation should precede or follow stabilization in SIJ?
No
377
Should you address form-closure or force-closure first?
Form-closure first, then force-closure
378
When an SIJ dysfunction diagnosis has been made, is there any evidence to support the notion that specific positional fault diagnosis of the sacrum or the innominate gives better outcomes than just sacral or innominate HVLA thrust irrespective of mal-alignment dysfunction
No
379
According to Childs et al in 2007, patients who completed the exercise intervention without manipulation were _x more likely to experiencing a worsening disability
8x
380
Kavcic et. al 2004: lumbar stability depends on __ trunk muscles
all
381
Stuge et al. 2004, 2006: effective tx of PPPP was best achieve when the ___ spinal musculature was included
Entire
382
Almeida et al. 2010: Intravaginal pressure increased from __ mmHg to __ mmHg immediately following a sacral HVLAT
56.01 - 64.65
+8.64
383
Osterbauer et al. 1993 and Cibulka et al. 1998: T or F: HVLAT to the SIJ statistically improved pain and disability
True
384
Clements et al. 2001, T or F: AA ROT asymmetry was restored regardless if the HVLAT was applied unilateral towards the restriction, or away from it.
True
385
What are the goals of HVLAT to the SIJ?
Decrease pain
Increase ROM
Reduce Disability
Increase muscle strength "force closure"
Improve feed forward activation times
Maybe put it back in place
386
Is there any substantatial evidence that supports or refutes the hypothesis that a reversal of a positional fault is the predominant mechanisms of action for MWM, although improvements in ROM have been shown?
No
386
Timgren and Soinilla 2006: Following an ankle HVLAT or SIJ MET all patients had an immediate...?
At 6 months?
Reestablishment of pelvic symmetry
6 months: 88% improvement
387
Hungerford et al. In patients with posterior pelvic pain, the WB innominate rotated _____ with single leg stance?
In subjects without pain...?
It anteriorly rotated and translated inferiorly
Without pain: the WB innominate posteriorly rotated and translated superiorly
388
Stuge et al 2004, 2006: T or F: HVLAT to the SIJ improved immediate form closure
True
389
Lewitt 1985: Are manipulation and mobilization used synonymous?
Yes
390
Mennell 1960: Manipulation is a manual procedure used to treat ___ dyfunction
JOINT dysfunction
391
Cyriax: Passive movement of a joint with therapeutic intent, using the ____
hands
392
Maitland 1986: There's two definitions of manual therapy
Loosely and restricted?
Loosely refers to any kind of passive movement
Restricted is a small amplitude, rapid movement (not necessarily at end range), that the pt cannot prevent
393
HVLAT American Heritage Dictionary:
to operate or control by skilled use of the hands
394
Paris 1979 HVLAT:
Skilled passive movement of a joint
395
APTA 1999 and APTA 2000 definitions of HVLAT
1999: Manipulation is a small amplitude high velocity, Mobilization is variable amplitude and speeds
2000: Manip = mob
396
Grade V vs. HVLAT
Grade V is more of a school definition involving oscillations or an audible pop
HVLAT is more for the neurophysiological effects:
1. Immediate reduction in paravertebral mm tone
2. Immediate increases in cervical flexor strength (Metcalfe 2006)
3. Immediate improvement in LM TrA contraction (Gill and Brenner 2007)
397
VA Chiropractor's Association of Spinal Manip vs. Mob
Manip: Cavitation/pop
Mob: No caviation or pop
398
What is the problem with CS HVLAT research?
Few, Small, Poor, Inconclusive
1. There's only a few RCTs
2. Most have small sample size and poor methodology
3. SRs are inconclusive
Bronfort, Gross, Haneline, and Vernon
399
CS HVLAT: Chronic neck pain
is HVLAT or MOB superior?
Neither is superior. Both are effective
400
CS HVLAT: WAD:
Who found HVLAT is effective in acute WAD?
Fernandez de-las Penas 2004
FernanWAD
401
CS HVLAT: HA/Dizziness:
Which authors looked at:
RCT for CGH using mob/HVLAT?
SR for TTH and HVLAT?
SR for HA and HVLAT?
RCT for CGH using mob/HVLAT? Jull 2002 (JG)
SR for TTH and HVLAT? Lenssinck 2004 (Lens-Tension)
SR for HA and HVLAT? Astin Ernst 2002 (H-ASTIN)
402
T or F: There are low quality RCTs for cervicogenic dizziness, but they are finding a positive result from MT
True
403
CS HVLAT: Is there sufficient evidence to draw conclusions for radiating arm pain?
No - Cagnie 2008
404
What is the mean thrust duration according to Ngan 2005?
158 ms
405
According to Triano 1992, what is the physiological reaction time, essentially when the biomechanical effects are completed before any protective muscular response?
What manipulation did he look at?
135 ms
C2/3 lateral break
406
According to Herzog 2005, what is the required speed for a cervical and lumbar manipulation?
CSP: 80 ms
LSP: 200 ms
407
What is the pre-thrust rotation accoridng to Ngan and Triano Schults?
Rotation: 30-54 degrees
Flexion: 2-30 degrees
Lateral bending: 6-46 degrees
408
According to Ngan, what is the mean de-rotation?
4.8 degrees
409
What is the mean peak acceleration?
2183 deg/s/s
410
Do you need to rotate/flex down to the level?
no
411
With Ross et al. how far away was the average cavitation from the targeted joint in the lumbar?
3.9 cm
412
Ross et al deemed what % of thrusts affected the targeted jonit?
46%
413
Fernandez de las penas: Following a C5-6 HVLAT how much did the pain threshold increase on the ipsilateral vs. contralateral side
Ipsilateral: 35.5%
Contralateral: 24.8%
414
Cochrane (Gross) Review 2004: In summary, Manipulation/Mob for neck pain is what level of evidence?
Moderate to very low level of evidence
415
What are the measurements for a c-spine manipulation?
30 ROT
46 SB
2 degrees flexion above C3, 2 degrees extension below C3
416
What is the required force for a cervical manip?
118N
417
What is the required force for a thoracic manip?
238N
418
What is the average degree velocity of a manip?
72 deg/sec
419
What is the peak DEGREE velocity of a manip?
127 deg/sec
420
What is the average time for a cervical manipulation?
< 135 ms
421
Summarize the UK Beam Trial outcomes
Exercise alone = no benefit at 12 months.
Anything with SMT = small, but significant benefit at 12 months
422
What are the 3 conclusions from the UK Beam Trial
1. SMT at 12 weeks = significant benefit
2. SMT is cost effective
3. SMT alone gives better value for money than SMT+exercise
423
How much blood flow comes from the ICA's vs. the VBA?
80% ICA
20% VBA
424
Does Laslett HVLAT the SIJ?
No. He stopped doing mob/manip due to poor outcomes. SMT is unsuccessful or aggravates symptoms.
425
What are the major complications of NSAIDs?
Adverse events:
Significant complications:
Hospitalizations:
Deaths:
Adverse events: 25%
Significant complications: 1-4%
Hospitalizations: > 100k/yr
Deaths: 16.5k/yr
426
What are the major side effects on NSAIDs?
- GOSH BA
GI ulceration
Bleeding
Hepatorenal dysfunction
Organ failure
Skin reactions
Accelerated cartilage destruction
427
LS HVLA is ___ times safer than NSAIDS for a LS disc herniation
37K-148K
428
Cervical: Time to peak force?
0.135 sec
429
Cervical: How fast?
80-200 ms
430
Cervical: Mean time of SMT:
158ms/135ms
431
Cervical: Velocity of SMT
127/sec
432
Cervical: Force?
118N
433
Cervical: Mean duration of SMT
102ms/80-100ms
434
Cervical how many cracks?
2.5
435
Cervical: Acute neck pain, number of SMT's per week?
4 SMTs/3 weeks
436
Cervical: Chance of adverse event?
1/1.3M
437
Cervical ROM testing compared to VA strain
1.2-12.5%
438
Cervical: HVLAT average strain on VA
6.2%
439
Cervical: % of mechanical failure of VA
139-162%
440
Lumbar Force
500N
441
Thoracic Force:
238N
442
Thoracic: mean duration of SMT
150-200ms/120-200ms
443
Thoracic preload:
24N
444
Thoracic avg. rate of force
1368 N/s
445
Thoracic movement at peak force
9.8 mm (1cm)
446
Thoracic skin lock
33-38 mm (3cm)
447
Thoracic, avg number of clicks
2-6 cavitations
448
Thoracic: average error from target
3.5cm
449
Lumbar: average error from target
5.29cm
450
Thoracic: movement of vertebrae (mm)
6-12mm anteriorly and 3-6mm laterally
451
Thoracic: movement of vertebrae (deg)
0.4-1.2 deg axial
0.5-1.8 deg sagittal
452
Sympathetic efferent to the UE is ____ and to the head it's ____.
UE: T5-9
Head: T1-4
453
How can rib dysfunction cause arm pain via the sympathetic system?
The sympathetic chain interface with the white rami communicates up or down 5 levels and out to the upper limbs via the satellite ganglion, which is anterior to the 1st rib
454
What are the scalene's attachment points?
Anterior C3-6 and insert on the posterior tubercles to R1,2
455
How can a rib manipulation decrease arm pain?
Mechanoreceptors in the facet joint capsule and ligaments in the paravertebral muscles may be responsible for altered afferent barrage and inhibition of the alpha motor neuron pool excitability levels, thus immediate reduction in segmentally association.
456
Which muscle has been shown in the literature by Lindgren Leino 1998 to repeatedly compress the brachial plexus?
The anterior scalene
457
What were the main findings from Boyle 1999 regarding shoulder impingement?
Palpate the 2nd rib, posterior scalene's, and lower CS mobility. Additionally the signs and symptoms may NOT always be reproducible with R2 accessory motion.
458
According to Maigne in 1991, what does the dorsal ramus of the 2nd thoracic do, and where is it located?
It provides cutaneous distribution to the posterolateral shoulder
It's nerve continues just lateral to the acromion. It is often limited caudally by the rib and laterally by the superior costotransverse ligament
459
According to McGuckin in 1986, What is T4 syndrome?
Glove like paresthesia
Pain in one or both limbs
Sympathetic changes:
1. Triple response of Lewis
2. Cold hands, discoloration, mottled, clammy
3. Head and neck symptoms, nausea, vomiting, dizziness
4. severe TTP to superior light touch over fixated segment
Tx: manipulate facet (costovertebral)
460
Who was the first to describe 2nd rib syndrome?
Grieve 1998
- He's grieving cause I ain't never heard of him.
461
Indahl: How much reduction in MUAP (motor unit action potentials) of the multifidus within 30 seconds of saline injected into the lumbar ZJ?
74%
462
Indahl: Summary
(Inner-network)
The outer annulus of the disc, capsule of the ZJ, ligaments, and paraspinal muscles have an innervation network that is probably part of the proprioception system that recruits muscles for motion and stabilization of motion segments
463
How can we reduce the muscle spasm of the thoracic spine?
E-stim elicits a reflex
HVLAT elicits a stretch reflex and causes inhibition.
464
What % of individuals with WAD had dizziness/vertigo?
20-58% - Wrisley 2000
80-90% - Heikkila 2000
465
Who first described CG Dizziness?
Ryan and Cope 1955
Ryan cope'd with the dizziness
466
Who found that vertigo could be induced by changes of position of the neck?
LuxON 1984 - brought ON the dizziness
467
How can vertigo be caused neck position?
It is a malfunction or disturbance in afferent flow of impulses from deep cervical tissues and cervical proprioceptors
468
In CG Dizziness, what is the dizziness proportioned too?
The CS pain, stiffness, or numbness
469
Which studies show that HVLAT is effective to manage dizzines?
Cote 1991
Cagle 1995
Cronin 1997
The Cervicogenic C squad
470
How does manual therapy restore dizziness?
restore normal arthrokinematics of the ZJ and normal afferent input will also be restored to the dorsal roots of C2-3, which synapses with the nucleus abducens in the vestibular nuclei
471
Who first introduced CGH?
Sjaastad 1983 - can't speak
472
What is the cervicogenic neuroanatomy?
CN5 (Trigeminal) and the C1-3 segments converge in the brainstem, which is why the pain may refer to the trigeminal nerve distribution.
Additionally, the trigeminocervical nucleus also receives afferents from CN 7, 9, 10 (Facial, Vagus, Hypoglossal)
473
Fernandez de las penas observed that with the lateral glide test the hypomobile side move ____ mm than the contralateral side
3.44 mm
