Journal of Manipulative and Physiological Therapeutics RSS feed: Current Issue. Journal of Manipulative and Physiological Therapeutics (JMPT) is dedicated to the advancement of chiropractic health care. It provides the latest information on current developments in therapeutics, as well as reviews of clinically oriented research and practical information for use in clinical settings. The Journal's editorial board includes some of the world's leading clinical low-back and spine researchers from medicine, osteopathy, chiropractic, and post-secondary education. JMPT , the premier biomedical publication in the chiropractic profession, publishes peer-reviewed original articles, case reports, journal abstracts, commentary, and new media reviews. Readers include chiropractors, osteopaths, physical therapists, physiatrists, radiologists, and sports medicine specialists. JMPT is the only chiropractic journal included in Index Medicus. It is also indexed/abstracted in Current Contents/Clinical Medicine and Index to Chiropractic Literature. Special discount of $99 offered to COCA members.http://www.jmptonline.org/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Journal of Manipulative and Physiological Therapeutics0161-4754332February 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jmptonline.org/article/PIIS0161475410000242/abstract?rss=yesEditorial Board10.1016/S0161-4754(10)00024-2Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3IFCIFChttp://www.jmptonline.org/article/PIIS0161475410000229/abstract?rss=yesAbstract: There is a stigma surrounding the reporting of conflicts of interest (COIs) that should be overcome. This article provides a discussion about COI, a brief historical review of requirements, and an update of policy for the Journal of Manipulative and Physiological Therapeutics that includes the alignment of the International Committee of Medical Journal Editors new COI form requirement. This article reviews types of COI and suggests that professions (eg, chiropractic, physical therapy, acupuncture) not directly affiliated with pharmaceutical and device companies, though they may be faced with different circumstances, should still comply with current COI reporting standards. There should be no disgrace in properly declaring interests; instead, COI declaration should be considered an important part of publication and recognized as an honorable action. Declaration of COI helps to provide transparency and disclosure to all involved including editorial staff, peer reviewers, and the readers.Conflict of Interest in Scientific Publications: A Historical Review and UpdateClaire Johnson10.1016/j.jmpt.2010.01.004Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Editorial8186http://www.jmptonline.org/article/PIIS0161475409003224/abstract?rss=yesJMPT HighlightsClaire Johnson10.1016/j.jmpt.2009.12.010Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-38787http://www.jmptonline.org/article/PIIS0161475409003170/abstract?rss=yesAbstract: Objective: The purpose of this study was to evaluate standard measures of health behavior for association with back pain among college students using data from the standardized National College Health Assessment survey. This investigation evaluated potential risk factors among a population of students at a Colorado university.Methods: This cross-sectional study included 963 survey results that were assessed using backward selection logistic regression techniques to evaluate the associations between common college-life health behaviors and back pain occurrence within the past school year.Results: Thirty-eight percent of college students surveyed reported having back pain within the past school year. Investigators found that univariate associations included multiple domains, but only psychosocial factors remained statistically significant in a final regression model and were associated with back pain. Feeling chronically fatigued (odds ratio, 3.89; 95% confidence interval, 1.09-13.86) and being in an emotionally abusive relationship (odds ratio, 2.78; 95% confidence interval, 1.69-4.57) were the factors most strongly associated with back pain in the final model.Conclusions: Psychosocial factors were identified to be associated with back pain. The prevalence of back pain among this younger population is of significant concern and warrants further investigation to identify contributing factors that may help in the development of interventions to reduce the epidemic of back pain within college students and lessen the burden upon college health providers.Risk Factors Associated With Back Pain: A Cross-Sectional Study of 963 College StudentsDavid P. Gilkey, Thomas J. Keefe, Jennifer L. Peel, Osama M. Kassab, Catherine A. Kennedy10.1016/j.jmpt.2009.12.005Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Original Articles8895http://www.jmptonline.org/article/PIIS0161475409003169/abstract?rss=yesAbstract: Objective: The purpose of this study was to examine the effect of manipulative therapy on the shoulder girdle, in addition to usual care provided by the general practitioner, on the outcomes of physical examination tests for the treatment of shoulder complaints.Methods: This was a randomized controlled trial in a primary care setting in the Netherlands. A total of 150 participants were recruited from December 2000 until December 2002. All patients received usual care by the general practitioner. Usual care included one or more of the following depending on the needs of the patient: information/advice, oral analgesics or nonsteroidal antiinflammatory drugs, corticosteroid injections, exercises, and massage. In addition to usual care, the intervention group received manipulative therapy, up to 6 treatment sessions in a 12-week period. Twenty-four physical examination tests were done at baseline and after 6, 12, and 26 weeks. Factor analysis was done to reduce the number of outcome measures.Results: The factor analysis resulted in 4 factors: “shoulder pain,” “neck pain,” “shoulder mobility,” and “neck mobility.” At 6 weeks, no significant differences between groups were found. At 12 weeks, the mean changes of all 4 factors favored the intervention group; the factors “shoulder pain” and “neck pain” reached statistical significance (95% confidence interval [CI], 0.1-2.1). At 26 weeks, differences in the factors “shoulder pain” (95% CI, 0.0-2.6), “shoulder mobility” (95% CI, 0.2-1.7), and “mobility neck” (95% CI, 0.2-1.3) statistically favored the intervention group.Conclusion: In this pragmatic study, manipulative therapy, in addition to usual care by the general practitioner, diminished severity of shoulder pain and neck pain and improved shoulder and neck mobility.Manipulative Therapy in Addition to Usual Care for Patients With Shoulder Complaints: Results of Physical Examination Outcomes in a Randomized Controlled TrialGert J. Bergman, Jan C. Winters, Klaas H. Groenier, Betty Meyboom-de Jong, Klaas Postema, Geert J. van der Heijden10.1016/j.jmpt.2009.12.004Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Original Articles96101http://www.jmptonline.org/article/PIIS0161475409003182/abstract?rss=yesAbstract: Objective: Clinical evidence has shown that extremity dysfunction, such as muscle weakness or inhibition, is associated with spinal disorders. Spinal manual therapy is a common therapeutic approach used to address extremity muscle weakness. The purpose of the study was to assess changes in the maximal muscle strength of the shoulder external rotators immediately and at 10, 20, and 30 minutes after cervical joint mobilization at the C5-6 segment.Methods: Eighteen participants with existing or a history of neck pain were screened by 2 investigators independently for muscle weakness of shoulder external rotators. Fifteen qualified participants underwent shoulder external rotator strength testing with a handheld dynamometer. Each participant was tested 6 times, twice before, immediately after, and at 10, 20, and 30 minutes after a C5-6 joint mobilization on the involved side. The 2 strength data collected before the mobilization were used to determine intratester reliability.Results: The intratester reliability of the shoulder external rotator strength was excellent (intraclass correlation coefficient3,2 = 0.985). One-way analysis of variance with repeated measures showed a statistical significance in strength data (P = .002). Post hoc tests revealed a significant increase between prejoint mobilization and immediately postjoint mobilization (P = .003) and between pre joint mobilization and 10-minute post joint mobilization (P < .001).Conclusions: The results of the study suggest that C5-6 joint mobilization increases muscle strength of the shoulder external rotators immediately and its effect carries over for 10 minutes but not after 20 minutes.Immediate and Carryover Changes of C5-6 Joint Mobilization on Shoulder External Rotator Muscle StrengthSharon S. Wang, Jim Meadows10.1016/j.jmpt.2009.12.006Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Original Articles102108http://www.jmptonline.org/article/PIIS0161475409003194/abstract?rss=yesAbstract: Objective: Spinal manipulation with high-velocity and low-amplitude (HVLA) manipulation is frequently used for the treatment of lumbopelvic pain; however, the effect on the pelvic floor has been poorly studied in the past. The objective of this study was to quantify the intravaginal pressure (IVP) and the basal perineal tonus (BPT), measured in terms of pressure, before and after the HVLA manipulation in patients without neuromuscular and skeletal dysfunctions.Methods: In this experimental, noncontrolled, nonrandomized study, IVP was obtained through a perineometer introduced into the volunteers' vagina while in dorsal horizontal decubitus. Forty young, healthy university volunteer women with no history of vaginal delivery participated. All voluntary contractions of the perineal muscles were measured in 3 different ways: phasic perineal contraction (PPC), tonic perineal contraction, and perineal contraction associated to accessory muscles. New pressure measurements were obtained immediately after the HVLA manipulation on the volunteers' sacrum. The pressures were registered and transcribed directly to a personal computer with specific software.Results: The average IVPs obtained in millimeters of mercury before and after the HVLA manipulation were 56.01 (±25.54) and 64.65 (±25.63) for PPC, 445.90 (±186.84) and 483.14 (±175.29) for tonic perineal contraction, and 65.62 (±26.56) and 69.37 (±25.26) for perineal contraction associated to accessory muscles, respectively. There was significant statistical variation only for PPC (P = .0020) values. The BPT increased regardless of the type of contraction (P < .05).Conclusion: High-velocity and low-amplitude manipulation of the sacrum was associated with an increase of PPC and of BPT in women who had no associated osteoarticular diseases. These preliminary discoveries could be helpful in the future study of the treatment of women with perineal hypotony.Effects of High-Velocity, Low-Amplitude Spinal Manipulation on Strength and the Basal Tonus of Female Pelvic Floor MusclesBerta Simon Nogueira de Almeida, José Hugo Sabatino, Paulo César Giraldo10.1016/j.jmpt.2009.12.007Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Original Articles109116http://www.jmptonline.org/article/PIIS0161475409003200/abstract?rss=yesAbstract: Objective: High-velocity, low-amplitude (HVLA) manipulation is an effective treatment of low back pain (LBP); however, the corresponding mechanisms are undetermined. Hypoalgesia is associated with HVLA manipulation and suggests specific mechanisms of action. An audible pop (AP) is also associated with HVLA manipulation; however, the influence of the AP on the hypoalgesia associated with HVLA manipulation is not established. The purpose of the current study was to observe the influence of the AP on hypoalgesia associated with HVLA manipulation.Methods: The current study represents a secondary analysis of 40 participants. All participants underwent thermal pain sensitivity testing to their leg and low back using protocols specific to Aδ fiber-mediated pain and temporal summation. Next, participants received HVLA manipulation to their low back, and the examiner recorded whether an AP was perceived. Finally, participants underwent immediate follow-up thermal pain sensitivity testing using the same protocols. Separate repeated-measure analyses of variance (ANOVAs) were used to observe changes in pain sensitivity before and immediately after HVLA manipulation.Results: Hypoalgesia of Aδ fiber-mediated pain was observed in the low back after HVLA (P < .05), and this was independent of whether an AP was perceived (P > .05). Hypoalgesia of temporal summation was observed in the lower extremity after HVLA (P < .05), and this was independent of whether an AP was perceived (P = .08). However, a moderate effect size for temporal summation was observed favoring participants in whom an AP was perceived.Conclusion: The current study suggests hypoalgesia is associated with HVLA manipulation and occurs independently of a perceived AP. Inhibition of lower extremity temporal summation may be larger in individuals in whom an AP is perceived, but further study is necessary to confirm this finding.The Relationship of the Audible Pop to Hypoalgesia Associated With High-Velocity, Low-Amplitude Thrust Manipulation: A Secondary Analysis of an Experimental Study in Pain-Free ParticipantsJoel E. Bialosky, Mark D. Bishop, Michael E. Robinson, Steven Z. George10.1016/j.jmpt.2009.12.008Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Original Articles117124http://www.jmptonline.org/article/PIIS0161475409003145/abstract?rss=yesAbstract: Objective: The purpose of this study was to investigate and measure the variable morphologies of axis vertebrae and explore the clinical significance of variations as it may pertain to clinical palpation and diagnostic imaging.Methods: The common variable morphologies in 100 specimens of intact dry adult axis vertebrae (Chinese) were investigated and measured. The frequencies in deviation of odontoid processes, deviation of spinous processes, and presence of bifid spinous processes were observed. The distances between the apices of transverse processes and inferior articular facets were also measured.Results: Variable morphologies of C2 that we observed were deviation of odontoid processes (14 cases, 14.0%), deviation of spinous processes (3 cases, 3.0%), and bifid spinous processes (95 cases, 95.0%). Of the bifid spinous processes, 56 had a process on the left side equal to the right side, 21 were longer on the left, and 18 were longer on the right. The distances between apices of transverse processes and inferior articular facets in the left side of C2 were 17.67 ± 2.47 mm, and that of the right side were 17.81 ± 2.55 mm.Conclusions: Because variable morphology of the axis is common, congenital deviation of the odontoid process, deviation of the spinous process, and asymmetrical bifid spinous processes should be taken into account during clinical palpation and diagnostic imaging.Variable Morphology of the Axis Vertebrae in 100 Specimens: Implications for Clinical Palpation and Diagnostic ImagingFan Ji-Hong, Wu Li-Ping, Li Yi-Kai, Liang Bo-Jin, Manas Das, Fu Xiao-Yong10.1016/j.jmpt.2009.12.002Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Original Articles125131http://www.jmptonline.org/article/PIIS0161475409003157/abstract?rss=yesAbstract: Objective: The purpose of this study was to investigate and measure morphological changes in the vertebral canal and its cast form at the level of the cervical spine in vitro during flexion, extension, and lateral bending in cadaver specimens.Methods: The morphological changes of vertebral canal and its contents were investigated and measured during experimental flexion, extension, and lateral bending of the cervical spine with 10 fresh specimens (Chinese); the cross-sections and sagittal diameters were also measured by pouring liquid wax into the intervertebral canal.Results: During lateral bending, the nucleus pulposus was pushed to the opposite side and the inferior cervical nerve roots of the opposite side were stretched. Cross-sectional diameter at the level of C6-7 during flexion was larger than that in lateral bending (P < .05). Comparing extension with flexion, we found that changes in all segments' areas were significant (P < .05). There was no significant difference in the sagittal diameter at any segment during all postures (P > .05).Conclusions: During lateral bending, the nucleus pulposus of neck were pushed into the opposite side, and inferior cervical nerve roots of the opposite side were stretched. The C5, C6, and C7 nerve roots appeared to undergo excessive stretch when an excessive lateral bending beyond the physiologic range was undergone. This study provides some additional evidence about the mechanics of cervical spine motion.Morphological Changes of the In Vitro Cervical Vertebral Canal and Its Cast Form During Flexion, Extension, and Lateral BendingWu Li-Ping, Li Yi-Kai, Liang Bo-Jin, Manas Das, Fan Ji-Hong10.1016/j.jmpt.2009.12.003Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Original Articles132137http://www.jmptonline.org/article/PIIS0161475409003212/abstract?rss=yesAbstract: Objective: The purpose of this study was to systematically review the literature evaluating the reliability and validity of all available methods for measuring active and passive cervical range of motion (CROM).Methods: Electronic databases (PubMed, MEDLINE, CINAHL, EMBASE, and AMED) were searched through OVID from their inception to January 2008. Articles were selected according to a priori defined criteria. Data were extracted regarding publication details, type of study, movements and device evaluated, subject and observer characteristics, and measurement protocol including blinding and statistical analysis methods. Quality assessment was undertaken using developed criteria to assess internal validity, external validity, and statistical methods. An estimate of the level of reliability and validity was calculated and used to categorize studies as good, moderate, or poor.Results: A total of 56 articles fulfilled the selection criteria and were included in the review. Forty-six of these articles described 66 reliability studies and 21 described 21 concurrent criterion validity studies. Twelve different methods were evaluated. Although it was the intention of this review to conduct meta-analysis, this was deemed inappropriate due to studies being too heterogeneous. Most of the reliability and validity studies involved asymptomatic subjects measured by allied health professionals investigating active ROM. Devices that were deemed to have “good” reliability and validity were the CROM device, the Spin-T goniometer, and the single inclinometer.Conclusions: A considerable number of reliability and concurrent validity studies have been published for CROM. The CROM device has undergone most evaluation and has been shown to be clinimetrically sound. Further research with significantly improved methodology and reporting is warranted for all devices.A Systematic Review of Reliability and Validity Studies of Methods for Measuring Active andPassive Cervical Range of MotionMark A. Williams, Christopher J. McCarthy, Angeliki Chorti, Matthew W. Cooke, Simon Gates10.1016/j.jmpt.2009.12.009Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Literature Review138155http://www.jmptonline.org/article/PIIS0161475409003133/abstract?rss=yesAbstract: Objective: The aim of this case series is to describe the effect of nerve mobilization techniques in the standard conservative management of cubital tunnel syndrome (CTS).Methods: Seven patients with CTS participated in this study. Inclusion criteria were having grade 1 and grade 2 entrapment neuropathy according to the McGowan grading system and no other neuropathies. In the evaluation, gripping with grip dynamometer; palmar gripping with a pinchmeter; pain level and Tinel sign with visual analog scale; sensibility with Semmes-Weinstein monofilaments; and functional status of the patients with the Turkish version of the Disability of Arm, Shoulder, and Hand Index were performed before starting a rehabilitation program, at the end of the 8-week rehabilitation program, and at 12-month follow-up. The physiotherapy program consisted of cold application, pulsed ultrasound, nerve mobilization techniques, strengthening exercises, postural adaptations, patient education, and ergonomic modifications.Results: Pain; Tinel sign; and Disability of Arm, Shoulder, and Hand Index scores were decreased, whereas grip and pinch strength increased in the observation period for these 7 patients.Conclusion: This case series demonstrated that conservative treatment of CTS may be beneficial for selected patients with mild to moderate symptoms. The treatment included neurodynamic mobilizations, including sliding techniques and tensioning techniques, which are thought to enhance ulnar nerve gliding and restore neural tissue mobility. Conservative treatment using neurodynamic mobilization with patient education and activity modification demonstrated some long-term positive results.Neurodynamic Mobilization in the Conservative Treatment of Cubital Tunnel Syndrome: Long-Term Follow-Up of 7 CasesDeran Oskay, Aydın Meriç, Nuray Kirdi, Tüzün Firat, Çiğdem Ayhan, Gürsel Leblebicioğlu10.1016/j.jmpt.2009.12.001Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Case Report156163http://www.jmptonline.org/article/PIIS0161475410000199/abstract?rss=yesIn the article “Chiropractic practice in the Danish public health care sector: a reflection and clarification of context, terms of usage, and selected design considerations for a planned qualitative investigation” by Myburgh in the Nov/Dec 2009 issue (2009 Nov-Dec;32(9):799-803; doi:10.1016/j.jmpt.2009.10.011), the figure captions were incorrect. The correct captions should read as follows: “Fig 2. Organizational structure of the Ringe spine center” and “Fig 1. An analogy for IgLHCS criteria drawn from advances in automobile safety technology. Printed with permission—Cats Citroën.”Errata10.1016/j.jmpt.2010.01.001Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Errata164164http://www.jmptonline.org/article/PIIS0161475410000205/abstract?rss=yesIn the article “Best practices recommendations for chiropractic care for infants, children, and adolescents: results of a consensus process” by Hawk et al in the October 2009 issue (2009 Oct;32(8):639-47; doi:10.1016/j.jmpt.2009.08.018), Julie Plezbert, DC, should have been included in the acknowledgments.ErratumClaire Johnson10.1016/j.jmpt.2010.01.002Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Errata164164http://www.jmptonline.org/article/PIIS0161475410000217/abstract?rss=yesIn the article “Cost minimization analysis of low back pain claims data for chiropractic vs medicine in a managed care organization” by Grieves et al in the Nov/Dec 2009 issue (2009 Nov-Dec;32(9):734-9; doi:10.1016/j.jmpt.2009.10.001), the following clarification should be included: “Dr Pursel is the director of chiropractic services at the HMO that sourced the data.” In addition, should read as follows:ErratumClaire Johnson10.1016/j.jmpt.2010.01.003Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3Errata164164http://www.jmptonline.org/article/PIIS0161475410000254/abstract?rss=yesContents10.1016/S0161-4754(10)00025-4Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3FrontmatterA1A1http://www.jmptonline.org/article/PIIS0161475410000266/abstract?rss=yesInformation for Readers10.1016/S0161-4754(10)00026-6Journal of Manipulative and Physiological Therapeutics 33, 2 (2010)2010-02-01Journal of Manipulative and Physiological Therapeutics2010-02-01332S0161-4754(10)X0003-3FrontmatterA2A2