Abstract
Objective: To determine the relative effect of instrument-delivered thrust cervical manipulations
in comparison with traditional manual-delivered thrust cervical manipulations in the
treatment of cervical spine dysfunction. Design: Prospective, randomized, comparative clinical trial. Setting: Outpatient chiropractic clinic, Technikon Natal, South Africa. Patients: Thirty patients diagnosed with neck pain and restricted cervical spine range of motion
without complicating pathosis for at least 1 month were included in the study. Interventions: The patients were randomized into 2 groups. Those in one group received mechanical
force, manually assisted (MFMA) manipulation to the cervical spine, delivered by means
of a hand-held instrument (Activator II Adjusting Instrument). Those in the other
group received specific contact high-velocity, low-amplitude (HVLA) manipulation consisting
of standard Diversified rotary/lateral break techniques to the cervical spine. Each
group received only the specific therapeutic intervention, no other treatment modalities
or interventions (including medication) being used, until asymptomatic status was
achieved or a maximum of 8 treatments had been received. Main Outcome Measures: Both treatment groups were assessed through use of subjective (Numerical Pain Rating
Scale 101, McGill Short-Form Pain Questionnaire, and Neck Disability Index) and objective
(goniometer cervical range of motion) measurement parameters at specific intervals
during the treatment period and at 1-month follow-up. The data were assessed through
use of 2-tailed nonparametric paired and unpaired analysis, descriptive statistics,
and power analysis of the data. Results: The results indicate that both treatment methods had a positive effect on the subjective
and objective clinical outcome measures, no significant difference being observed
between the 2 groups (P <.025). The subjective data from all 3 questionnaires showed statistically significant
changes from initial to final consultations as well as from initial consultation to
1-month follow-up (P <.025). The objective range of motion measures showed statistically significant changes
in the MFMA group for left and right rotation and left and right lateral flexion from
initial consultation to final consultations and for right rotation and right lateral
flexion from initial consultation to 1-month follow-up. The HVLA group showed only
the change in left rotation from initial to final consultations and from initial consultation
to 1-month follow-up to be statistically significant. Conclusions: The results of this clinical trial indicate that both instrumental (MFMA) manipulation
and manual (HVLA) manipulation have beneficial effects associated with reducing pain
and disability and improving cervical range of motion in this patient population.
A randomized, controlled clinical trial in a similar patient base with a larger sample
size is necessary to verify the clinical relevance of these findings. (J Manipulative
Physiol Ther 2001;24:260-71)
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Manipulative & Physiological TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Spinal manipulation.Spine. 1994; 19: 858-861
- Spinal manipulation and mobilisation for back and neck pain: a blinded review.BMJ. 1991; 303: 1298-1303
- Spinal manipulation for low-back pain.Ann Intern Med. 1992; 117: 590-598
- Manipulation and mobilization of the cervical spine: a systematic review of the literature.Spine. 1996; 21: 1746-1759
- Disorders of the cervical spine: diagnosis and medical management.2nd ed. WB Saunders, Philadelphia1994
- Neck pain in the general population.Spine. 1994; 19: 1307-1309
- Mechanoreceptor endings in human cervical facet joints.Spine. 1994; 19: 495-501
- Neural elements in human cervical intervertebral discs.Spine. 1992; 17: 132-135
- The innervation of the cervical intervertebral discs.Spine. 1988; 13: 2-8
- The clinical anatomy of the cervical dorsal rami.Spine. 1982; 7: 319-330
- A correlation of cervical magnetic resonance imaging and discography/computed tomographic discograms.Spine. 1994; 19: 2819-2825
- Cervical discogenic pain: prospective correlation of magnetic resonance imaging and discography in asymptomatic subjects and pain sufferers.Spine. 1996; 21: 300-311
- Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain.Pain. 1993; 55: 99-106
- The prevalence of chronic cervical zygapophysial joint pain after whiplash.Spine. 1995; 20: 20-25
- Chronic cervical zygapophysial joint pain after whiplash: a placebo-controlled prevalence study.Spine. 1996; 21: 1737-1744
- The validation of the diagnosis “joint dysfunction” in the synovial joints of the cervical spine.J Manipulative Physiol Ther. 1990; 13: 7-12
- Foundations of chiropractic: subluxation.Mosby, St. Louis1995
- Mechanical, physiologic, and neuromuscular considerations of chiropractic treatments.in: Advances in chiropractic. Mosby-Year Book, St. Louis1996: 269-285
- On sounds and reflexes.J Manipulative Physiol Ther. 1996; 19: 216-218
- Reflex responses associated with manipulative treatments on the thoracic spine: a pilot study.J Manipulative Physiol Ther. 1995; 18: 233-236
- Reflex response associated with manipulative treatment of the thoracic spine.J Neuromusculoskeletal Syst. 1994; 2: 124-130
- Job analysis of chiropractic: a project report, survey analysis and summary of the practice of chiropractic within the United States.National Board of Chiropractic Examiners, Greeley (CO)1993
- Time course considerations for the effects of unilateral lower cervical adjustments with respect to the amelioration of cervical lateral-flexion passive end-range asymmetry.J Manipulative Physiol Ther. 1990; 13: 297-304
- Effectiveness of upper versus lower cervical adjustments with respect to the amelioration of passive rotational versus lateral-flexion end-range asymmetries in otherwise asymptomatic subjects.J Manipulative Physiol Ther. 1992; 15: 99-105
- The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial.J Manipulative Physiol Ther. 1992; 15: 570-575
- The effect of manipulation on pain and range of motion in the cervical spine: a pilot study.J Manipulative Physiol Ther. 1992; 15: 495-500
- Three-dimensional head kinematics and clinical outcome of patients with neck injury treated with spinal manipulative therapy: a pilot study.J Manipulative Physiol Ther. 1992; 15: 501-511
- The Neck Disability Index: a study of reliability and validity.J Manipulative Physiol Ther. 1991; 14: 409-415
- The measurement of clinical pain intensity: a comparison of six methods.Pain. 1986; 27: 117-126
- The McGill Questionnaire: appraisal and current status.in: Handbook of pain assessment. The Guilford Press, New York1992: 152-168
- Reliability of measurements of cervical spine range of motion: comparison of three methods.Phys Ther. 1991; 71: 98-104
- Compendium of chiropractic technique.in: Canadian Memorial Chiropractic College Technical Publications, Toronto1990: 46 (50,57,60,77)
- The importance of statistics in research design.in: Clinical research methodology for complimentary therapies. Hodder & Stroughton, London1994: 3-20
- Lasting changes in passive range motion after spinal manipulation: a randomized, blind, controlled trial.J Manipulative Physiol Ther. 1996; 19: 165-168
- The immediate effect of manipulation vs. mobilization on pain and range of motion in the cervical spine: a randomized controlled trial.J Manipulative Physiol Ther. 1993; 16: 279-280
- Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study.J Manipulative Physiol Ther. 1990; 13: 13-16
- Manipulation of the cervical spine: a pilot study.J R Coll Gen Pract. 1983; 33: 574-579
- Manipulation for chronic neck pain: a double-blind controlled study.Spine. 1982; 7: 532-535
- Intensive training, physiotherapy, or manipulation for patients with chronic neck pain: a prospective, single-blinded, randomized clinical trial.Spine. 1998; 23: 311-318
- The effects of spinal manipulation on cervical kinesthesia in patients with chronic neck pain: a pilot study.J Manipulative Physiol Ther. 1997; 20: 80-85
- Comparison of 2 chiropractic techniques on pain and lateral flexion in neck pain patients: a pilot study.Chiropr Technique. 1996; 8: 155-162
- Activator methods chiropractic technique.Mosby-Year Book, St. Louis1997
- Biomechanical characterization (fingerprinting) of five novel methods of cervical spine manipulation.J Manipulative Physiol Ther. 1993; 16: 573-577
- Brain stem infarction due to chiropractic manipulation of the cervical spine.South Med J. 1983; 76: 1199-1201
- Dissecting aneurysm of the vertebral artery and cervical manipulation: a case report with autopsy.Neurology. 1989; 39: 512-515
- A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain.Neurosurgery. 1993; 33: 73-78
- Failure of clinical tests to predict cerebral ischemia before neck manipulation.J Manipulative Physiol Ther. 1989; 12: 304-307
- Safety in chiropractic practice, I; the occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988.J Manipulative Physiol Ther. 1996; 19: 371-377
- Safety in chiropractic practice, II: treatment to the upper neck and the rate of cerebrovascular incidents.J Manipulative Physiol Ther. 1996; 19: 563-569
- Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation.Spine. 1999; 24: 785-794
- Complications of spinal manipulation: a comprehensive review of the literature.J Fam Pract. 1996; 42: 475-480
- Safety in chiropractic practice, II: treatment to the upper neck and the rate of cerebrovascular incidents.J Manipulative Physiol Ther. 1997; 20: 567-568
- Electromyographic responses of back and limb muscles associated with spinal manipulative therapy.Spine. 1999; 24: 146-152
- Forces and relative vertebral movements during SMT to unembalmed post-rigor human cadavers: peculiarities associated with joint cavitation.J Manipulative Physiol Ther. 1995; 18: 4-9
- Forces exerted during spinal manipulative therapy.Spine. 1993; 18: 1206-1212
- Validation of the force and frequency characteristics of the activator adjusting instrument: effectiveness as a mechanical impedance measurement tool.J Manipulative Physiol Ther. 1999; 22: 75-86
- Muscular and mechanical behavior of the lumbar spine in response to dynamic posteroanterior forces.in: Proceedings of the 26th annual meeting of the International Society for the Study of the Lumbar Spine International Society for the Study of the Lumbar Spine, Toronto1999: 136A
- Neurophysiological response to intraoperative lumbosacral spinal manipulation.J Manipulative Physiol Ther. 2000; 23: 447-457
- Articular neurology, altered biomechanics, and subluxation pathology.in: Activator methods chiropractic technique. Mosby-Year Book, St. Louis1997: 19-64
- Responses of mechanosensitive afferents to manipulation of the lumbar facet in the cat.Spine. 1995; 20: 2379-2385
- Articular neurology and manipulative therapy.in: 2nd ed. Aspects of manipulative therapy. p. 72-7. Churchill-Livingstone, New York1985
- Electromyographic reflex response to mechanical force, manually-assisted spinal manipulative therapy.Spine. 2001; (In press)
- Articular neurology and manipulative therapy.in: Idczak RM Dewhurst D Glasgow EF Tehan P Ward AR Apects of manipulative therapy, Proceedings of a Multidisciplinary International Conference on Manipulative Therapy, Melbourne, August, 1979 Lincoln Institute of Health Sciences, Carlton, Australia1980: 67-72
- Sensory mechanisms of the spinal cord.2nd ed. Plenum Press, New York1991
- Electromyography as a tool to document diagnostic findings and therapeutic results associated with somatic dysfunctions in the upper cervical spinal joints and sacroiliac joints.Manual Medicine. 1986; 2: 53-58
- Randomized comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up.BMJ. 1995; 311: 349-351
- Manipulative therapy versus education programs in chronic low back pain.Spine. 1995; 20: 948-955
- A randomized clinical trial of manual therapy and physiotherapy for persistent back and neck complaints: subgroup analysis and relationship between outcome measures.J Manipulative Physiol Ther. 1993; 16: 211-219
- Randomized clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up.BMJ. 1992; 304: 601-605
- The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints: a randomized clinical trial.Spine. 1992; 17: 28-35
- A blinded randomized clinical trial of manual therapy and physiotherapy for chronic back and neck complaints: physical outcome measures.J Manipulative Physiol Ther. 1992; 15: 16-23
Article info
Publication history
Received in revised form:
June 14,
2000
Received:
February 25,
2000
Footnotes
☆bPrivate practice of chiropractic, Phoenix, Ariz.
☆☆This research was supported in part by a grant from the National Institute of Chiropractic Research.
★This study was submitted as a dissertation to the Faculty of Health, in compliance with the requirements for the masters degree in technology: chiropractic, at the Technikon Natal, South Africa. The abstract of this manuscript was presented at the 5th Biennial Congress of the World Federation of Chiropractic, Auckland, New Zealand, May 17-22, 1999.
★★Submit reprint requests to: Christopher J. Colloca, DC, State of the Art Chiropractic Center, PC, 11011 S 48th St, Suite 205, Phoenix, AZ 85044. E-mail: [email protected]
♢J Manipulative Physiol Ther 2001;24:260-71
Identification
Copyright
© 2001 JMPT. Published by Elsevier Inc. All rights reserved.
