Cervical Biomechanics
Essential Literature
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Determining Cavitation Location During Lumbar and Thoracic SMT
Bereznick 2004
Conclusion:
It appears that SMT is not as accurate as once assumed. Perhaps the clinical response is the result of the fact that, in most cases, many cavitations occur during a single manipulative procedure. By this “shotgun” approach, the offending joints are manipulated and the patient responds. On the other hand, a general mechanical effect on tissues near the symptomatic site may be sufficient to produce effects. Whatever the case, techniques used to “target” treatment to a joint may not be necessary, but if accuracy is required, other techniques may need to be used.
Basic Science Research Related Chiropractic Spinal Adjusting
The Frictional Properties at the Skin-Fascia interface
Bereznick et. al. 2002
Conclusion:
The skin–fascia interface over the thoracic spine exhibits negligible friction. This suggests that efforts to apply an oblique force during thoracic manipulation may be wasted effort. These novel results then challenge the concept that directional specificity during spine manipulation is required to generate desirable therapeutic outcome.
Does Inter-Vertebral Range of Motion Increase After Spinal Manipulaiton?
Branney et. al 2014
Conclusion:
This study found no differences in cervical sagittal IVRoM between patients with mild non-specific neck pain and matched healthy controls and motion palpation over-estimated the prevalence of hypomobile segments. There was, however, a modest positive relationship between the number of spinal manipulations given and detectable increases in sagittal segmental IV-RoM. The patient-reported outcomes of spinal manipulation were not related to this, nor was there any relationship between increase in range and improvement in pain and disability, even though these improvements were generally large.
Interexaminer Reliability of Cervical Motion Palpation Using Confidence Levels
Cooperstein et. al 2013
Conclusion:
The palpators in this study of cervical end-feel MP exhibited good interexaminer agreement, with findings generally within one level of each other, despite having used industry- standard methods that previous studies had found mostly unreliable. Examiner confidence levels seemed to have a modest impact on the reliability of cervical spine motion palpation.
Motion Palpation Used as A Post-Manipulation Assessment Tool
Lakhani et. al. 2009
Conclusion:
The findings of this study showed that motion palpation of end-feel assessment appears to be a responsive postmanipulation assessment tool in the cervical spine for determining whether perceived motion restriction found before treatment improves after SMT. This observation may be limited to symptomatic participants.
Coupling Behavior of The Cervical Spine
Cook et. al. 2006
Conclusion:
These findings suggest that use of 3-dimensional analyzed cervical coupling patterns for the lower cervical vertebral during apposition and treatment application may show clinical use for manual clinicians. The use of directional coupling based on 2-dimensional cervical coupling patterns or upper cervical spine coupling that addresses C1-2 should be questioned.
An Investigation Into the Validity of Cervical Motion Palpation
Humphreys et. al. 2004
Conclusion:
This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a ‘gold standard’ (Congenital Block Vertebrae) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixation
Efficacy of Cervical Endplay Assessment as an Indicator For SMT
Haas et. al. 2003
Conclusion:
Endplay assessment in and of itself did not contribute to the same-day pain and stiffness relief observed in neck pain patients receiving spinal manipulation. The impact on a longer course of treatment remains to be investigated. The data suggest that pain modulation may not be limited to mechanisms associated with manipulation of putative motion restrictions.