Applied kinesiology research and literature compendium

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Participants: Eighteen patients (mean age, 30.5 ± 13.0 years) with either unilateral (n = 14) or bilateral (n = 4) anterior knee pain. Results: Patients showed substantial muscle inhibition in the involved and the contralateral legs as estimated by the interpolated twitch technique. After the manipulation, a decrease in muscle inhibition and increases in knee extensor torques and muscle activation were observed, particularly in the involved leg. In patients with bilateral anterior knee pain, muscle inhibition was decreased in both legs after sacroiliac joint adjustment. Conclusions: Spinal manipulation might offer an interesting alternative treatment for patients with anterior knee pain and muscle inhibition. Because this clinical outcome study was of descriptive nature rather than a controlled design, biases might have occurred. Thus the results have to be verified in a randomized, controlled, double-blinded trial before firm conclusions can be drawn or recommendations can be made.

Cervical root compression monitoring by flexor carpi radialis H-reflex in healthy subjects, Sabbahi M, Abdulwahab S.

Spine, 1999 Jan 15;24(2):137-41.
STUDY DESIGN: One-group, pretest-postest experimental research with repeated measures. OBJECTIVE: To determine the effect of head postural modification on the flexor carpi radialis H-reflex in healthy subjects. SUMMARY OF BACKGROUND DATA: H-reflex testing has been reported to be useful in evaluating and treating patients with lumbosacral and cervical radiculopathy. The idea behind this technique is that postural modification can cause further H-reflex inhibition, indicating more compression of the impinged nerve root, or recovery, indicating decompression of the root. Such assumptions cannot be supported unless the influence of normal head postural modification on the H-reflex in healthy subjects is studied. METHODS: Twenty-two healthy subjects participated in this study (14 men, 8 women; mean age, 39 +/- 9 years). The median nerve of the subjects at the cubital fossa was electrically stimulated (0.5 msec; 0.2 pulses per second [pps] at H-max), whereas the flexor carpi radialis muscle H-reflex was recorded by electromyography. The H-reflexes were recorded after the subject randomly maintained the end range of head-forward flexion, backward extension, rotation to the right and the left, lateral bending to the right and the left, retraction and protraction. These were compared with the H-reflex recorded during comfortable neutral positions. Data were recorded after the subject maintained the position for 30 seconds, to avoid the effect of dynamic postural modification on the H-reflex. Four traces were recorded in each position. During recording, the H-reflex was monitored by the M-response to avoid any changes in the stimulation-recording condition. RESULTS: Repeated multivariate analysis of variance was used to evaluate the significance of the difference among the H-reflex, amplitude, and latency, in various head positions. The H-reflex amplitude showed statistically significant changes (P < 0.001) with head postural modification. All head positions, except flexion, facilitated the H-reflex. Extension, lateral bending, and rotation toward the side of the recording produced higher reflex facilitation than the other positions. These results indicate that H-reflex changes may be caused by spinal root compression-decompression mechanisms. It may also indicate that relative spinal root decompression occurs in most head-neck postures except forward flexion. CONCLUSIONS: Head postural modification significantly influences the H-reflex amplitude but not the latency. This indicates that the H-reflex is a more sensitive predictor of normal physiologic changes than are latencies. The H-reflex modulation in various head positions may be-caused by relative spinal root compression-decompression mechanisms.

Comment: In AK, the cervical compaction test was developed to monitor this kind of phenomenon. With compression upon the top of the skull, MMT will reveal weaknesses when cervical spine subluxations, and especially cervical disc syndromes are present. This study measures this dynamic.

Electromyographic responses of back and limb muscles associated with spinal manipulative therapy, Herzog, W., Scheele, D., Conway, P.J.

Spine, 1999;24:146-152
Study Design: Ten young, asymptomatic male subjects underwent 11 clinically relevant spinal manipulative treatments along the length of the spine to test the magnitude and extent of reflex responses associated with the treatments. Objectives: To determine the magnitude and extent of reflex responses elicited by spinal manipulative treatments.

Summary of Background Data: Spinal manipulative treatments have been associated with a reflexogenic relief of pain and a loss of hypertonicity in muscles within the treatment area. However, there is no study in which results show the probability of occurrence or the extent of reflex responses during spinal manipulative treatments. Methods: Asymptomatic subjects received spinal manipulative treatments on the cervical, thoracic, and lumbar levels and on the sacroiliac joint. Reflex activities were measured using 16 pairs of bipolar surface electrodes placed on the back and proximal limb musculature. The percentage of occurrence and the extent of reflex responses in the back and proximal limb musculature were determined. Results: Each treatment produced consistent reflex responses in a target-specific area. The reflex responses occurred within 50-200 msec after the onset of the treatment thrust and lasted for approximately 100-400 msec. The responses were probably of multireceptor origin and were elicited asynchronously. Conclusions: This is the first study in which results show a consistent reflex response associated with spinal manipulative treatments. Because reflex pathways are evoked systematically during spinal manipulative treatment, there is a distinct possibility that these responses may cause some of the clinically observed beneficial effects, such as a reduction in pain and a decrease in hypertonicity of muscles.

Orthostatic intolerance and chronic fatigue syndrome associated with Ehlers-Danlos syndrome, Rowe PC, Barron DF, Calkins H, Maumenee IH, Tong PY, Geraghty MT

J Pediatr, 1999 Oct;135(4):494-9.
OBJECTIVE: To report chronic fatigue syndrome (CFS) associated with both Ehlers-Danlos syndrome (EDS) and orthostatic intolerance. STUDY DESIGN: Case series of adolescents referred to a tertiary clinic for the evaluation of CFS. All subjects had 2-dimensional echocardiography, tests of orthostatic tolerance, and examinations by both a geneticist and an ophthalmologist. RESULTS: Twelve patients (11 female), median age 15.5 years, met diagnostic criteria for CFS and EDS, and all had either postural tachycardia or neurally mediated hypotension in response to orthostatic stress. Six had classical-type EDS and 6 had hypermobile-type EDS. CONCLUSIONS: Among patients with CFS and orthostatic intolerance, a subset also has EDS. We propose that the occurrence of these syndromes together can be attributed to the abnormal connective tissue in dependent blood vessels of those with EDS, which permits veins to distend excessively in response to ordinary hydrostatic pressures. This in turn leads to increased venous pooling and its hemodynamic and symptomatic consequences. These observations suggest that a careful search for hypermobility and connective tissue abnormalities should be part of the evaluation of patients with CFS and orthostatic intolerance syndromes.

Comment: The biomedical literature on orthostatic hypotension (a positive Ragland’s sign) is very extensive, and has been a part of standard AK evaluation of patients since 1965 when Dr. Goodheart first pointed out the significance of Adrenal Stress Disorder among chiropractic patients. Most chronic health disorders involving any of the three aspects of the triad of health (structural, chemical, mental) will demonstrate some involvement of the adrenal glands, and complete recovery from a chronic health disorder may require treatment of the adrenal stress disorder that may be present.

Sacroiliac joint involvement in activation of the porcine spinal and gluteal musculature, Indahl, A., Kaigle, A., Reikeras, O., Holm, S.H.

J Spinal Disord, 1999;12:325-30
Abstract: This experiment involved stimulation of the sacroiliac joint that was found to cause neuromuscular responses in the gluteus maximus, quadratus lumborum, and multifidus muscles. This muscular activation was found to assist in the control of locomotion and body posture and to provide stability to the sacroiliac joint and lumbar spine. Thus, sensitization of sacroiliac joint nociceptive afferents were suggested to not only contribute to mechanical low back pain, but plays a role also in sacroiliac joint biomechanics via reflexogenic activation of the trunk and gluteal muscles.

Comment: Given the results of this study, a larger double-blind study evaluating sacroiliac joint biomechanics in relationship applied kinesiology diagnostic procedures for the sacroiliac joint could be done, wherein back muscles strength tests are measured before and after a course of chiropractic care for the sacroiliac joints.

Sensorimotor control of the spine, Holm, S., Indahl, A., Solomonow, M.

Journal of Electromyography and Kinesiology, 12;3:219-234.
Abstract: The spinal viscoelastic structures including disk, capsule and ligaments were reviewed with special focus on their sensory motor functions. Afferent capable of monitoring proprioceptive and kinesthetic information are abundant in the disc, capsule and ligament. Electrical stimulation of the lumbar afferents in the discs, capsules and ligaments seem to elicit reflex contraction of the multifidus and also longissimus muscles. The muscular excitation is pronounced in the level of excitation and with weaker radiation 1 to 2 levels above and below. Similarly, mechanical stimulation of the spinal viscoelastic tissues excites the muscles with higher excitation intensity when more than one tissue (ligaments and discs for example) is stimulated. Overall, it seems that spinal structures are well suited to monitor sensory information as well as to control spinal muscles and probably also provide kinesthetic perception to the sensory cortex.

EMG recordings of abdominal and back muscles in various standing postures: validation of a biomechanical model on sacroiliac joint stability, Snijders, C.J., Ribbers, M.T., de Bakker, H.V., Stoeckart, R., Stam, H.J.

J Electromyogr Kinesiol, 1998;8:205-14
Abstract: In a biomechanical model we described that for stability of the flat sacroiliac joints (SIJ) muscle forces are required which press the sacrum between the two hip bones (self-bracing). Shear loading of these joints is caused by gravity and longitudinally oriented muscles. Protection against shearing can come from transversely oriented muscles like the internal oblique (OI) abdominal muscles. For validation we used standing postures with significantly more or less OI activity compared to activity in a standardized erect standing reference posture. OI activity decreased significantly when (a) resting on one leg (the contralateral), as can be observed at bus stops, (b) tilting the pelvic backward and (c) applying a pelvic belt. We explain this decrease of OI activity by, respectively, decrease of gravity load, decrease of load from the psoas major muscles, and a substitute of self-bracing. The outcome of this study is in line with the biomechanical model on SIJ stability. Clinical relevance of this study regards aspecific low back pain and is found in the effect of the use of a pelvic belt, of a trunk position as adopted when wearing a small rucksack and of the benefit of exercising trunk muscles in extension and torsion.

The Anatomical Basis for the Effectiveness of Chiropractic Spinal Manipulation in Treating Headache, Hack G

Proceedings of the 1998 International Conference on Spinal Manipulation: Vancouver, British Columbia, Canada July 16-19;1998:114-15
Abstract: While the notion that headache may arise from neck structures is new to some medical practitioners, it is a concept widely accepted by the chiropractic profession. Chiropractors regularly perform manipulative procedures involving the cervical spine to relieve headache. Interestingly, an increasing body of literature relates headaches to pathology affecting the cervical spine and a number of clinical trials have demonstrated that chiropractic spinal manipulation directed at the neck I valuable for managing headaches. One possible anatomical basis could be a recently identified muscle-dura (myodural) bridge located at the craniocervical junction.

Dialogue between the CNS and the immune system in lymphoid organs, Straub RH, Westermann J, Scholmerich J, Falk W

Immunol Today, 1998 Sep;19(9):409-13.
Abstract: It is well known that the CNS influences the responses of the immune system via humoral substances such as cortisol. Here, Rainer Straub and colleagues discuss aspects of the local interaction between nerves and immune cells in lymphoid organs. They provide evidence for chemically mediated transmission between nerves and immune cells in the spleen that is modified by the microenvironment.

Comment: The close association of autonomic nerve terminals with macrophages and lymphocytes facilitates a chemically mediated transmission between nerves and immune cells. This study strongly suggests that spinovisceral reflex effects might include alterations in the functional activity of cells in the immune and/or inflammatory responses. It is demonstrable with MMT that there is a relationship between the immune system and the muscular, adrenal, and nervous systems. The doctor and the patient can detect this interplay during MMT, and therapy for immune dysfunction resulting from nervous system dysfunction appropriately employed.

The Role of the Chiropractic Adjustment in the Care and Treatment of 332 Children with Otitis Media, Fallon, J.

Journal of Clinical Chiropractic Pediatrics, 1997 Oct; 2(2) :167-83
Objective: To conduct a pilot study of chiropractic adjustive care on children with otitis media using tympanography as an objectifying measure, and to propose possible mechanisms whereby subluxation is implicated in the pathophysiology of otitis media. Design: Case series Setting: Subjects presented in a private clinical practice in New Rochelle, New York. The subjects were referred by various sources including pediatricians, other MDs, chiropractors and parents. Participants: 332 children who presented consecutively with previously diagnosed otitis media, ages 27 days to 5 years. Main Outcome Measures: A survey of the parent/guardian was used to determine historical data with respect to previous otitis media bouts, age of onset of initial otitis media, feeding history, history of antimicrobial therapy, referral patterns, and birth history. Otoscopic and tympanographic data was collected as well as data concerning the number of adjustments administered to produce resolution of the otitis media. Data with respect to recurrence rates over six months was also collected. Results: The average number of adjustments administered by types of otitis media were as follows: acute otitis media (n=127) 4.0±1.03, chronic/serous otitis media (n=104) 5.1±1.53, for the mixed type of bilateral otitis media (n=10) 5.3±1.35 and where no otitis was initially detected on otoscopic and tympanographic exam (but with history of multiple bouts) (n=74) 5.88±1.87. The number of days it took to normalize the otoscopic examination was for acute 6.67±1.9 chronic/serous 8.57±1.96, and 10.18±3.39, and mixed 10.9±2.02. The overall recurrence rate over a six month period from initial presentation in the office was for acute 11.02%, chronic/serous 16.34%, for mixed 30% and for none present 17.56%. Conclusion: To our knowledge this is the first time that tympanography has been used as an objectifying tool with respect to the efficacy of the chiropractic adjustment in the treatment of children with otitis media. As tympanography has been used extensively in the medical assessment of children with otitis media, it also serves as a bridge from which the chiropractic field and the medical field can begin to communicate with respect to otitis media. The results indicate that there is a strong correlation between the chiropractic adjustment and the resolution of otitis media for the children in this study. Normal cranial molding, which is essential for the proper juxtaposition of the cranial bones, often does not occur in the case of a birth malposition, as well as in the case of the child born with the aid of a C- section. This pilot study can now serve as a starting point from which the chiropractic profession can begin to examine its role in the treatment of children with otitis media. Large-scale clinical trials need to be undertaken in the field using tympanography as an objectifying measure. In addition, the role of the occipital adjustment needs to be examined. This study begins the process of examining the role of the vertebral cranial subluxation complex in the pathogenesis of otitis media, and the efficacy of the chiropractic adjustment in its resolution.

A Kaminski-type evaluation of cranial adjusting, Pederick F.O.

Chiropractic Technique, 1997;9(1):1-15.

Abstract: Models for the evaluation of chiropractic methods have been proposed in the past. This paper uses one model as a framework for the evaluation of cranial adjusting. Chiropractors and osteopaths have been involved in the cranial field for almost 70 years. Over this time, a body of literature has been amassed on clinical experience and research. This article defines and describes one type of cranial adjusting technique and develops a hypothetical model of effects influencing cranial motion. It also discusses measurable observation, particularly in relation to cranial bone motion, and reviews the available literature about experimentation and testing of the technique. Although further experimentation and clinical trials are needed, the type of cranial adjusting technique described has a sound scientific basis as mainstream chiropractic techniques and should receive provisional acceptance within the chiropractic and other professions as an integral part of the chiropractic armamentarium.

Reduced muscle function in patients with osteoarthritis, Fisher NM, Pendergast DR.
-- Department of Rehabilitation Medicine, State University of New York at Buffalo, USA.

Scand J Rehabil Med.1997 Dec;29(4):213-21
Abstract: The purpose of this study was to determine whether subjects with knee osteoarthritis (OA) had reduced muscle strength at various muscle lengths, endurance, contraction velocity and functional capacity, compared with control subjects and whether the decrease was related to functional capacity. Forty-five men and 45 women with knee OA were compared with a control group (41 males, 63 females) of similar age for functional capacity, maximal isometric strength (in vivo length-tension relationship) and endurance (in vivo force-time relationship) of knee flexion and extension and maximal angular velocity (in vivo force-velocity relationship) of knee extension. The OA subjects had increased difficulty (2.03 +/- 0.53) and pain (1.65 +/- 0.29) for activities of daily living (ADLs) and significantly lower strength for extension (72%) and flexion (56%), endurance for the quadriceps (203%) and hamstrings (214%) and velocity (128%). The reductions were greater at longer muscle lengths. These data demonstrate that patients with knee OA have reduced muscle function and functional capacity compared to controls.

Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation, Fisher NM, White SC, Smolinski RJ, Pendergast DR.

Disabil and Rehabil.1997 Feb;19(2):47-55
Abstract: Patients with knee osteoarthritis (OA) have reduced functional capacity and muscle function that improves significantly after quantitative progressive exercise rehabilitation (QPER). The effects of these changes on the biomechanics of walking have not been quantified. Our goal was to quantify the effects of knee OA on gait before and after QPER. Bilateral kinematic and kinetic analyses were performed using a standard link-segment analysis on seven women (60.9 +/- 9.4 years) with knee OA. All functional capacity, muscle function and gait variables were initially reduced compared to age-matched controls. Muscle strength, endurance and contraction speed were significantly improved (55%, 42% and 34%, respectively) after 2 months of QPER (p < 0.05), as were function (13%), walking time (21%), difficulty (33%) and pain (13%). There were no significant changes in the gait variables after QPER. To use the QPER improvements to the best advantage, gait retraining may be necessary to "re-programme' the locomotor pattern.

Spinal manipulation results in immediate H-reflex changes in patients with unilateral disc herniations, Floman Y, Liram N, Gilai AN.

Eur Spine J. 1997;6(6):398-401.
Abstract: The aim of this clinical investigation was to determine whether the abnormal H-reflex complex present in patients with S1 nerve root compression due to lumbosacral disc herniation is improved by single-session lumbar manipulation. Twenty-four patients with unilateral disc herniation at the L5-S1 level underwent spinal H-reflex electro-physiological evaluation. This was carried out before and after single-session lumbar manipulation in the side-lying position. Eligibility criteria for inclusion in the study were: predominant sciatica, no motor or sphincteric involvement, unilateral disc herniation at the L5-S1 level on CT or MR imaging, age between 20 and 50 years. H-reflex responses were recorded bilaterally from the gastrosoleus muscle following stimulation of tibial sensory fibers in the popliteal fossa. H-reflex amplitude in millivolts (HR-A) and H-reflex latency in milliseconds (HR-L) were measured from the spinal reflex response. Pre- and post-manipulation measurements were compared between the affected side and the healthy side. Statistical evaluation was performed by the Wilcoxon matched-pairs test (SPSS). Thirteen patients displayed abnormal H-reflex parameters prior to lumbar manipulation, indicating an S1 nerve root lesion. The mean amplitude was found to be significantly lower on the side of disc herniation than on the normal, healthy side (P = 0.0037). Following manipulation, the abnormal HR-A increased significantly on the affected side while the normal HR-A on the healthy side remained unchanged (P = 0.0045). There was a significant difference between latencies on the affected side and those on the healthy side (P = 0.003). Following manipulation there was a trend toward decreased HR-L. However, this trend did not reach statistical significance (P = 0.3877). Eight patients displayed no H-reflex abnormalities before or after manipulation. Their respective HR-A and HR-L values did not change significantly following manipulation. Three additional patients were excluded due to technical difficulties in achieving manipulation or measuring spinal reflex. These observations may lend physiological support for the clinical effects of manipulative therapy in patients with degenerative disc disease.

The manual muscle examination for rotator cuff strength. An electromyographic investigation, Kelly BT, Kadrmas WR, Speer KP.

Am J Sports Med. 1996 Sep-Oct;24(5):581-8.
Abstract: The electromyographic activity of eight muscles of the rotator cuff and shoulder girdle (supraspinatus, infraspinatus, subscapularis, pectoralis, latissimus dorsi, and the anterior, middle, and posterior deltoid) was measured from the nondominant shoulders of 11 subjects during a series of 29 isometric contractions. The contractions simulated different positions used for strength testing of the rotator cuff and involved elevation, external rotation, and internal rotation at three degrees of initial humeral rotation (-45 degrees of internal rotation, 0 degree, +45 degrees of external rotation) and scapular elevation (0 degree, 45 degrees, 90 degrees). Isolation of the supraspinatus muscle was best achieved with the test position of elevation at 90 degrees of scapular elevation and +45 degrees (external rotation) of humeral rotation. Isolation of the infraspinatus muscle was best achieved with external rotation at 0 degree of scapular elevation and -45 degrees (internal rotation) of humeral rotation. Isolation of the subscapularis muscle was best achieved with the Gerber push-off test. This study used four criteria for identifying the optimal manual muscle test for each rotator cuff muscle: 1) maximal activation of the cuff muscle, 2) minimal contribution from involved shoulder synergists, 3) minimal provocation of pain, and 4) good test-retest reliability. Based on the results of this study and known painful arcs of motion, an objective identification of the optimal tests for the manual muscle testing of the cuff was elucidated.

Kinematic system demonstrates cranial bone movement about the cranial sutures, Lewandoski, MA, Drasby, E, Morgan, M, Zanakis, M

J Am Osteopath Assoc, 1996;96(9):551.

Disturbed eye movements after whiplash due to injuries to the posture control system, Gimse R, Tjell C, Bjorgen IA, Saunte C.

J Clin Exp Neurophychol, 1996;18(2):178-86.
Abstract: Self-reports after whiplash often indicate associations with vertigo and reading problems. Neuropsychological and otoneurological tests were applied to a group of whiplash patients (n = 26) and to a carefully matched control group. The whiplash group deviated from the control group on measures of eye movements during reading, on smooth pursuit eye movements with the head in normal position, and with the body turned to the left or to the right. Clinical, caloric, and neurophysiological tests showed no injury to the vestibular system or to the CNS. Test results suggest that injuries to the neck due to whiplash can cause distortion of the posture control system as a result of disorganized neck proprioceptive activity.

Comment: Central to the concept of applied kinesiology chiropractic evaluation and treatment is the consideration that the senses of seeing, hearing, smelling, tasting, feeling, and balance are not simple, specific sensations; rather they are sensory systems closely interrelated among themselves and intimately linked with motor functions. In applied kinesiology chiropractic methodology, a means for testing the integration of the muscles in the body with the visual reflexes has been termed ocular lock. It demonstrates the failure of the eyes to work together on a binocular basis through the cardinal fields of gaze. This is usually not gross pathology of cranial nerves III, IV, and VI; rather it is poor functional organization. Mechanical irritation of cranial nerves III, IV, or VI (usually VI) may be responsible for disturbed binocular function leading to discordant sensory inputs from the visual righting reflex. When the eyes are turned in a specific direction, a previously strong indicator muscle will weaken when the ocular lock test is positive, and there is probably disturbance in the visual righting, vestibulo-ocular, or opto-kinetic reflexes.

Normative values for isometric muscle force measurements obtained with hand-held dynamometers, Andrews AW, Thomas MW, Bohannon RW.
-- University of North Carolina Hospitals, Chapel Hill, 27514, USA.

Phys Ther. 1996 Mar;76(3):248-59. 
BACKGROUND AND PURPOSE: The extent of a patient's impairment can be established by comparing measurements of that patient's performance with normative values obtained from apparently unimpaired individuals. Only a few studies have described normative values for muscle strength measured by hand-held dynamometry. The purpose of this study of older adults, therefore, was to obtain normative values of maximum voluntary isometric force using hand-held dynamometers. SUBJECTS: One hundred fifty-six asymptomatic adults (77 men, 70 women) participated in this study. The subjects' mean age was 64.4 years (SD=8.3, range=50-79). The male subjects' mean age was 64.5 years (SD=8.4, range=50-79), and the female subjects' mean age was 64.3 years (SD=8.2, range=50-79). METHODS: Gender, age, dominant side, height, weight, and activity level were recorded. Eight upper-extremity movements (shoulder flexion, extension, abduction, and medial and lateral rotation; elbow flexion and extension; and wrist extension) and five lower-extremity movements (hip flexion and abduction, knee flexion and extension, and ankle dorsiflexion) were resisted by one of three experienced testers using a strain-gauge hand-held dynamometer. RESULTS: Gender, age, and weight were identified as independent predictors of force for all muscle actions on both the dominant and nondominant sides. These variables were used, therefore, to create regression equations and normative values for the force of each muscle action. CONCLUSION AND DISCUSSION: The reference values provided may allow clinicians who follow the described testing protocol to estimate the severity of force-generating impairments in patients aged 50 to 79 years.

Sacroiliac joint manipulation decreases the H-reflex, Murphy, B.A., Dawson, N.J., Slack, J.R.

Electromyogr Clin Neurophysiol, 1995;35:87-94
Abstract: Joint manipulation is widely utilized clinically to decrease pain and increase the range of motion of joints displaying limited mobility. Evidence of efficacy is based on subjective reports of symptom improvement as well as on the results of clinical trials. Experiments were designed to determine whether or not sacroiliac joint manipulation affects the amplitude of the Hoffman (H) reflex. Surface EMG recordings of the reflex response to electrical stimulation of the tibial nerve in the popliteal fossa were made from the soleus muscle. The averaged amplitudes of H-reflexes were compared on both legs before and after either sacroiliac joint manipulation or a sham procedure. H-reflex amplitude was significantly decreased (12.9%) in the ipsilateral leg (p < 0.001) following a sacroiliac joint manipulation while there was no significant alteration following the sham intervention. There was no significant alteration in reflex excitability in the contralateral leg to the sacroiliac joint manipulation. To further investigate the mechanism of these reflex alterations, the local anesthetic cream EMLA (Astra Pharmaceuticals) was applied to the skin overlying the sacroiliac joint and the experiments were repeated on a different group of subjects. This was intended to determine if excitation of cutaneous afferents was responsible for the reflex excitability changes. There was still a significant decrease in reflex excitability (10.6%) following sacroiliac joint manipulation (p < 0.001). These findings indicate that joint manipulation exerts physiological effects on the central nervous system, probably at the segmental level. The fact that the changes persisted in the presence of cutaneous anesthesia suggests that the reflex changes are likely to be mediated by joint and/or muscle afferents.

Comment: This study offers further elucidation of the finding of the physiological response of muscles to sacroiliac manipulation. One basic physiologic response to spinal manipulative therapy is a transient decrease or increase in motoneuron activity as assessed by the Hoffmann reflex (H-reflex) technique, depending upon the patients neuromuscular status at the time of measurement. The H-reflex technique involves peripheral stimulation of the Ia-afferent feedback pathway to assess the excitability of the alpha motoneuron. The MMT in AK evaluates the same neurological mechanism. This study shows that the clinical efficacy of SMT may involve a change in motoneuron activity which, in turn, may lead to a reduction in hypertonic as well as an increase in hypotonic muscles. Thus, a basic neurophysiologic response to SMT is muscular response to treatment.

A Preliminary Single Case Magnetic Resonance Imaging Investigation into Maxillary Frontal-Parietal Manipulation and Its Short-Term Effect upon the Intercranial Structures of an Adult Human Brain, Pick, M.

J Manipulative Physiol Ther. 1994;17(3)
Objective: To investigate the hypothesis that external cranial manipulation can cause change within the structures of the human brain. (42 y/o subject). Results: Second MRI showed elimination of a 5-mm peak along the superior border of the corpus collosum and a 4 - mm reduction in the width of the fornix column. The exposed anterior posterior wall of the lateral ventricle posterior to the fornix col. increased 51 degrees cephalad with the application (to the bregma and the maxillary palate). The angular surface of the central lobule altered by minus 7 degrees. The subject experienced no change in his asymptomatic condition as a result of this study. Conclusion: The present study supports the theory that external cranial manipulation affects the structure of the brain. It also suggests support for the theory regarding suture mobility.

The role of sensory information in the guidance of voluntary movement, McCloskey, D.I., Prochazka, A.

Somatosensory and Motor Research, 1994;11:69-76
Abstract: For voluntary movements to be well timed and accurate, they require coordinated tactile, visual and proprioceptive information about the movement in progress. Locomotion should be a stable cycle generated by the sensory links between the musculoskeletal system, the neural system and the environment.

Isokinetic Muscle Testing: Is It Clinically Useful?, Almekinders LC, Oman J.

J Am Acad Orthop Surg, 1994 Jul;2(4):221-225.
Abstract: The use of computer-driven muscle-testing devices has become increasingly popular during the past two decades. This expensive equipment allows evaluation of muscles and muscle groups in an isokinetic manner. Isokinetic muscle testing is performed with a constant speed of angular motion but variable resistance. Isokinetic dynamometers have been shown to produce relatively reliable data when testing simple, uniaxial joints, such as the knee, as well as when testing the spine in flexion and extension. Isokinetic strength data are generally not helpful in the diagnosis of orthopedic abnormalities. Isokinetic testing can be helpful during the rehabilitation of orthopedic patients, since it allows easy monitoring of progress. It also enables the patient to work on muscle rehabilitation in a controlled manner at higher speeds than are possible with more conventional exercise equipment. An isokinetic rehabilitation program can be easily tailored with concentric and eccentric components that closely resemble muscle actions during occupational and sports activities.

Various Forms of Chiropractic Technique, Bergmann, T.

Chiropractic Technique, May 1993; 5(2):53-5.
Doctors who noticed a regularity in their results and began to ask why those results occurred started the majority of chiropractic technique systems. The apparent fallacy to many of these system approaches is that the evaluative procedure linked to the manipulative procedure is often singular and very simplistic. The human body; however, is a very complex and integrative organism, and to rely on a single evaluative tool for the sole application of a therapeutic intervention should not be considered sound clinical practice. It has not been established that any adjective or evaluative procedure is more or less effective than any other for any condition. Studies comparing the effectiveness and efficiency of technique systems are long over due.

Role of cranial bone mobility in cranial compliance, Heisey, SR, Adams, T.

Neurosurgery, 1993;33(5):869-876.
Abstract: Increases in intracranial pressure are normally buffered by the displacement of blood and cerebrospinal fluid from the cranium when there is an increase in intracranial volume (ICV). How much pressure increases with an increase in ICV is expressed in the calculation of cranial compliance (delta ICV/delta P, where delta P is change in pressure) and elastance (delta P/delta ICV). Data reported here indicate that the movement of the cranial bones at their sutures is an additional factor defining total cranial compliance. Using controlled bolus injections of artificial cerebrospinal fluid into a lateral cerebral ventricle in anesthetized cats and a newly developed instrument to quantify cranial bone movement at the midline sagittal suture where the bilateral parietal bones meet, we show that these cranial bones move in association with increases in ICV along with corresponding peak intracranial pressures and changes in intracranial pressure. External restraints to the head restrict these movements and reduce the compliance characteristics of the cranium. We propose that total cranial compliance depends on the mobility of intracranial fluid volumes of blood and cerebrospinal fluid when there is an increase in ICV, but it also varies as a function of cranial compliance attributable to the movement of the cranial bones at their sutures. Our data indicate that although the cranial bones move apart even with small (nominally 0.2 ml) increases in ICV, total cranial compliance depends more on fluid migration from the cranium when ICV increases are less than approximately 3% of total cranial volume. Cranial bone mobility plays a progressively larger role in total cranial compliance with larger ICV increases.

Neuromuscular effects of temporomandibular joint dysfunction, Esposito, V., Leisman, G., Frankenthal, Y.

Intern J Neuroscience, 1993;68
Abstract: Neurologically intact male and female TMJ dysfunction patients with or without cervical spine involvement were examined using standard clinical neurologic testing for balance and coordination. Seventy percent of the TMJ patients without cervical involvement exhibited positive signs for balance, coordination, and/or ataxia found in response to having the patient’s mandible stressed by extending it a far as possible laterally, and also opened (as wide as possible) or closed (biting down). The performance of patients with cervical involvement was not significantly different than those without cervical involvement. Further examination of the relation between the TMJ and auditory, visual, cerebellar, and coordination mechanisms is therefore indicated.

The reflex effects of spinal somatic nerve stimulation on viscera function, Sato, A.

J Manipulative Physiol Ther, 1992;15(1):57-61
Abstract: This paper studies somatovisceral reflex responses in the cardiovascular organ, gastrointestinal tract, urinary bladder and adrenal medulla in anesthetized animals after eliminating emotional factors following somatic sensory stimulations. Various somatic sensory stimulations, including cutaneous, muscle and articular sensory stimulations, can produce differing autonomic reflex responses, depending on which visceral organs and somatic afferents are stimulated. Some responses have dominant sympathetic efferent involvement, whereas others have dominant parasympathetic efferent involvement. Some responses have propriospinal and segmental characteristics, while others have supraspinal and generalized characteristics in their reflex nature. These somatovisceral reflex responses may be functioning during spinal manipulative therapy in conscious humans.

Changes in Magnitude of Relative Elongation of the Falx Cerebri During the Application of External Forces on the Frontal Bone of an Embalmed Cadaver, Kostopoulos, D., Keramidas, G.

Journal of Craniomandibular Practice, January 1992.
Craniosacral therapy hypothesizes that light forces applied to the skull may be transmitted to the dural membrane having a therapeutic effect on the cranial system. This study examines the changes in elongation of falx cerebri during the application of craniosacral therapy techniques to the skull of an embalmed cadaver. The study demonstrates that the relative elongation of the falx cerebri changes as follows: for the frontal lift, 1.44 mm; for the parietal lift, 1.08 mm; for the sphenobasilar compression, -0.33mm; for the sphenobasilar decompression, 0.28 mm; and for the temporal ear pull, inconclusive results. Results showed that an elastic response began at 140 grams of frontal bone traction. At 642 grams the elastic response ended and viscous changes began. The present study offers validation for the use of craniosacral therapy and the hypothesis of cranial suture mobility.

Evaluation of neck muscle strength with a modified sphygmomanometer dynamometer: reliability and validity, Vernon HT, Aker P, Aramenko M, Battershill D, Alepin A, Penner T.
-- Canadian Memorial Chiropractic College, Toronto, Ontario.

J Manipulative Physiol Ther. 1992 Jul-Aug;15(6):343-9. 
OBJECTIVE: Determine test-retest reliability, normative data and clinical validity of isometric muscle strength testing in the neck with a modified sphygmomanometer dynamometer (MSD). DESIGN: Analytic survey. Paired trials of various muscle strength tests were conducted on convenience samples of normal subjects and consecutive samples of symptomatic subjects. SETTING: Outpatient chiropractic research clinic. PATIENTS/SUBJECTS: For study 2, 40 normal male subjects, average age 25 +/- 2 yr, were studied for reliability and normative data. For study 3, 24 symptomatic patients, 12 males and 12 females, average age 39 +/- 7 yr, were studied, 8 with "whiplash"-type injuries (average duration 22.5 wk) and 16 with nontraumatic chronic neck pain (average duration 110 wk). INTERVENTION: No therapeutic intervention is reported. MAIN OUTCOME MEASURE: Pressure levels generated by subjects against a modified sphygmomanometer-type dynamometer as measured in kilopascals. RESULTS: Study 1. Repeated paired trials of a standardized weight column (20 lbs) produced a coefficient of variation of 0.84% and virtually no difference between the means of the first vs. second trials. Study 2. High test-retest correlation coefficients were found for all ranges of motion (.79-.97). Right-to-left asymmetry in rotation and lateral flexion was within 6-8%. The flexion/extension ratio was .57:1, indicating that in normal subjects, flexion was approximately 40% lower than extension. Lower cutoffs were established as the mean--1 SD as follows (in kPa): flexion--3300, extension--5800, rotation--5200 and lateral flexion--6200. Coefficients of variation ranged from 25 to 29%. Study 3. Differences between paired trials were analyzed by intraclass coefficients, which were very high (.95-.99), and by percentages, which ranged from 4 to 10.4%, with an average of 7%, indicating a high degree of test-retest consistency. The mean values for all symptomatic subjects for flexion, extension, right rotation and right lateral bending were all well below the normal cutoff values as found in study 2. The flexion/extension ratio for whiplash subjects was 0.25:1.00, which is half of that of normal subjects. CONCLUSIONS: The MSD has been found to be a reliable instrument for the evaluation of isometric muscle strength in the neck in normal and symptomatic subjects. Normative values for absolute test levels, bilateral symmetry and flexion/extension ratios have been determined. A symptomatic group demonstrated significant deviations from these norms in the form of reduced strength levels and reduced flexion/extension ratios, while still maintaining very high levels of test-retest consistency and bilateral symmetry. The MSD appears very promising in the evaluation of neck-injured patients.

Postural control in young and elderly adults when stance is perturbed: kinematics, Alexander, N. B, Shepard, N, Gu, MJ, Schultz, A.

Journal of Gerontology, 1992; 47:M79-M87.
Abstract: Increased postural sway and falling are associated with aging and are likely related to problems with postural control in the elderly. We investigated the motions of individual body segments in 24 healthy young adults and 15 healthy elderly adults (mean ages 26 and 72) in response to four tasks: (a) standing with feet flat on an anteriorly accelerating platform (Flat Translation); standing on a narrow beam support that was (b) stationary (Beam Standing) and (c) accelerating anteriorly (Beam Translation); and (d) standing on a rotatable but otherwise stationary springboard (Springboard Standing). An optoelectronic camera system was used to measure rotations of body segments, particularly regarding their maximum excursions, time to first rotation response, direction of initial rotation, and time to first rotation reversal. In general, larger rotation excursions were noted in the elderly compared to the young group, particularly in the Beam Standing and Beam Translation tasks, but the magnitude of rotation difference was small. All rotation magnitudes were well within the available ranges of motion of the body joints. In both excursion magnitudes and directions of initial rotation, the elderly showed greater variability than the young. In the Beam Translation task, the elderly group, compared to the young, tended to rotate their upper body segments more than in the Flat Translation task. These data suggest that healthy elderly adults with no apparent musculoskeletal or neurological impairments have small but consistent differences in postural control kinematics, particularly when more challenging conditions are presented. Moreover, these data provide the basis for biomechanical analyses of joint torques and other dynamic requirements of these responses.

Comment: Manual muscle testing is the method of testing functional neurology and postural mechanisms in applied kinesiology. Normally there is predictable facilitation and inhibition of muscle function. When there is not, applied kinesiology testing methods are employed to discover and correct the factors responsible for the disturbance in predictable muscle function. The importance of restoring normal function in elderly patients is demonstrated by the postural kinematic disturbances of the patients in this study.

Case Study: The effect of utilizing spinal manipulation and craniosacral therapy as the treatment approach for attention deficit-hyperactivity disorder, Phillips, C.

Proceedings of the National Conference on Chiropractic, 1991 Nov:57-74
ABSTRACT: Due to the subjective nature of this disorder, evaluations and treatment results have considerable limitations and cannot be generalized to the entire population. It is this author's intent to describe an alternative treatment protocol and its effect on one subject. In this particular case, initial chiropractic spinal adjustive care was effective in reducing the frequency of ear infections, allergic reactions, and headaches, but was ineffective at decreasing the severity of ADHD characteristics. Incorporation of craniosacral therapy with spinal adjustive therapy resulted in a positive alteration in the ADHD symptomatology. The teacher's report of improvement in performance skills was significant as teacher ratings have been found to have empirical corroboration of ADD. While conclusions cannot be drawn based on a single case report, it was the opinion of this author that the results justified a more detailed analysis of this treatment protocol for ADD/ADHD. The NWCC Center for Clinical Studies has begun treatment on 17 additional patients with this disorder. If results are similar, a large scale research project will be implemented to investigate further the role that chiropractic spinal and cranial therapy may play in the treatment of Attention Deficit Hyperactivity Disorder.

The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity, Lund, J.P., et al.

Canadian Journal of Physiology and Pharmacology, 1991;69:683-694.
Abstract: Articles describing motor function in five chronic musculoskeletal pain conditions (temporomandibular disorders, muscle tension headache, fibromyalgia, chronic lower back pain, and postexercise muscle soreness) were reviewed. It was concluded that the data do not support the commonly held view that the pain of these conditions is maintained by some form of tonic muscular hyperactivity. Instead, it seems clear that in these conditions the activity of agonist muscles is often reduced by pain, even when this does not arise from the muscle itself. On the other hand, pain causes small increases in the level of activity of the antagonist. As a consequence of these changes, force production and the range and velocity of movement of the affected body part are often reduced. To explain how such changes in the behavior come about, we propose a neurophysiological model based on the phasic modulation of excitatory and inhibitory interneurons supplied by high-threshold sensory afferents. We suggest that the "dysfunction" that is characteristic of several types of chronic musculoskeletal pain is a normal protective adaptation and is not a cause of pain.

Comment: This paper articulates with fascinating similarity one of the major hypotheses in AK, namely that physical, chemical, or emotional imbalances produce secondary muscle dysfunction, specifically a muscle inhibition (usually followed by overfacilitation of an opposing muscle). Muscles lose function and become inhibited because of structural problems like trauma or chemical imbalance due to a hormonal influence or mental/emotional stress.

Effects of Soft Tissue Technique and Chapman's Neurolymphatic Reflex Stimulation on Respiratory Function, Lines, D., McMillan, A., Spehr, G.

J Aust Chiro Assoc 1990 Mar;20(1):17-22
Thirty asymptomatic subjects were treated on four separate occasions using soft tissue technique and Chapman's neurolymphatic reflex stimulation for the diaphragm. Spirometric assessment of respiratory function before and after each treatment was performed. Measurements of forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC% over the whole sample showed no significant improvement following the treatment regime. Eight of the thirty subjects had lower than predicted initial FVC and FEV1 values. Five of these subjects reported a past history of asthma or bronchitis. When the results for this group of eight subjects were analyzed separately, it was found that a significant improvement was attained from the first pre-treatment FVC to the last post-treatment FVC (paired t-test significant at alpha = 0.02). These results suggest that traditional chiropractic soft tissue and reflex techniques may have therapeutic value in the treatment of patients who exhibit below average respiratory function.

Limb Segment Information Transmission Capacity Infers Integrity of Spinothalamic Tracts and Cortical Visual-Motor Control, Leisman, G., Vitori, R.

International Journal of Neuroscience. 1990; 50:175-183.
Abstract: Limb segment movement times have been investigated previously in relation to Fitts’ Index of Difficulty (ID = log22A/W) over various movement distances. Results supported Fitts’ theory that different limb segments show different maximum information processing rates. The results indicated that visually-mediated discrete correction control processes are used. In the presently reported experiments, normal human subjects performed movements with left or right arms. Visual-motor control was inter- or intrahemispheric. Direction of movement was adductive or abductive. It was hypothesized that abductive movements are controlled by the contralateral hemisphere while adductive movements are controlled by either hemisphere. It was also hypothesized that abductive movements are related to the lateral system which projects to the contralateral side of the spinal cord. The control of adductive movements is related to the medial system which projects bilaterally to the spinal cord.

The Relationship Between CSF and Fluid Dynamics in the Neural
Canal, Flanagan, M.

J Manipulative Physiol Ther, Dec 1988;11(6):489-92
There is a relationship between fluid dynamics in the neural canal and cranial vault. This relationship can be affected by posture, respiration and pathology. In addition, several chiropractic disciplines [including applied kinesiology] have advocated that axial skeletal improprieties may also affect fluid dynamics in the canal and vault. This paper reviews literature pertinent to these issues. The information it contains is relevant to those disciplines that attempt to manipulate fluid dynamics in the canal and vault, as well as to those that treat neurological disorders.

Influence of different static head-body positions on spinal lumbar interneurons in man: the role of the vestibular system, Rossi A, Mazzocchio R.

ORL J Otorhinolaryngol Relat Spec, 1988;50(2):119-26.
Abstract: The present experiments were made in man with the aim of studying the possible influences of different head-body tilts on the activity of the interneurons Ia, Ib and the Renshaw cells functionally coupled to the soleus alpha-motoneurons. Subjects were seated on a chair, rotable with respect to the vertical axis, and were studied at 80 degrees and 40 degrees to the horizontal. The excitability of the soleus alpha-motoneurons slightly decreased when the body was placed at 40 degrees of backward inclination whereas the Renshaw cell activity showed a reinforcement of inhibition on the same motoneurons. The reciprocal inhibition from the anterior tibial to the soleus muscle increased at 40 degrees of backward inclination with respect to the control values at 80 degrees. Finally, short-latency homonymous facilitation and inhibition showed no significant change in relation to body position. The results indicate that different head-body positions are able to modify the bias of spinal interneurons in man. We discuss the hypothetical role of the vestibular system in producing the effects seen.

Comment: The labyrinthine and visual righting reflexes may be disturbed by joint or muscle problems in the neck, as well as by cranial faults that may result from either whiplash dynamics or a blow to the head during an automobile accident or other head and neck trauma. It is hypothesized in AK that temporal bone cranial faults can result in imbalance in one or both sternocleidomastoid and upper trapezius muscles due to mechanical irritation of cranial nerve XI as it exits the skull through the jugular foramina, and could thereby disturb the biomechanics of the joints in the neck. This phenomenon is found on a daily basis in the clinical setting, and muscles anywhere in the body may be facilitated by proper cranial therapy. Anatomical distortions of the geometry of the vestibular mechanism within the temporal bones (producing a tilt in the angular geometry of the semicircular canals) may create discordant sensory input into the CNS compared to that coming into it from the spinal joints and muscles, thereby producing poor stability and deficient motor activity.

Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing, Wadsworth CT, Krishnan R, Sear M, Harrold J, Nielsen DH.

Phys Ther. 1987 Sep;67(9):1342-7. 
Physical therapists require an accurate, reliable method for measuring muscle strength. They often use manual muscle testing or hand-held dynametric muscle testing (DMT), but few studies document the reliability of MMT or compare the reliability of the two types of testing. We designed this study to determine the intrarater reliability of MMT and DMT. A physical therapist performed manual and dynametric strength tests of the same five muscle groups on 11 patients and then repeated the tests two days later. The correlation coefficients were high and significantly different from zero for four muscle groups tested dynametrically and for two muscle groups tested manually. The test-retest reliability coefficients for two muscle groups tested manually could not be calculated because the values between subjects were identical. We concluded that both MMT and DMT are reliable testing methods, given the conditions described in this study. Both testing methods have specific applications and limitations, which we discuss.

Changes in Electrical Activity in Muscles Resulting from Chiropractic Adjustment: A Pilot Study, Shambaugh P.

J Manipulative Physiol Ther 1987;10(6):300-304
This study examines the effects of chiropractic adjustment on the muscles of the back. Vertebrae that are hypomobile may be held in that state by the erector spinae muscle group; adjusting such vertebrae should result in les muscle tension. By measuring the change in electrical activity, such relaxation can be observed. Hypomobile vertebrae were found by motion palpation. The patient was then placed prone and surface electrodes were placed over the upper trapezius, upper erector spinae (T3-T5), and lumbar erector spinae (L1-L3) muscle groups on both sides of the body. The patient was adjusted using full spine toggle recoil thrusts, and postadjustment readings were taken. Results from this study show that significant changes in muscle electrical activity occur as a consequence of adjusting. On average, a 25% reduction in muscle activity was observed across the 20 subjects tested, while no significant reductions were observed with the control group of 14 subjects. Significant reductions in side-to-side imbalances were also observed.

Quantifying the Effects of Spinal Manipulations on Gait, Using Patients with Low Back Pain: A Pilot Study, Herzog W, Nigg B, Robinson R, Read L.

J Manipulative Physiol Ther 1987;10(6):295-299
A pilot study was performed to investigate the effects of chiropractic treatment on the gait of one patient with a chronic sacroiliac joint syndrome. Qualitative and quantitative measures were used to describe pain, sacroiliac joint mobility, functional ability and gait patterns of this patient before and after receiving chiropractic treatment, and throughout the rehabilitation period. For this patient, chiropractic treatment reduced the low back pain and was associated with significant changes in selected gait parameters. A study involving 10-20 subjects is under way to possibly generalize the findings of this investigation.

Finger flexion function in rheumatoid arthritis: the reliability of eight simple tests, Armstrong R, Horrocks A, Rickman S, Heinrich I, Kay A, Gibson T.

Br J Rheumatol 1987;26:118-122.
The inter- and intra-observer errors of eight tests of finger flexion function were estimated from the results obtained by three observers assessing 10 patients with rheumatoid hand involvement. Measurements of finger flexion and muscle power involved both conventional and novel techniques using simple and easily constructed apparatus. For each test, measurements were in agreement between observers and were reproducible on three occasions. These tests may now be used with confidence by other investigators.

Functional assessment of the hand: reproducibility, acceptability, and utility of a new system for measuring strength, Helliwell P, Howe A, Wright V.

Ann Rheum Dis 1987;46:203-208
A new system for measuring strength of the hand using a torsion dynamometer linked to a microprocessor is described. The system permits analysis of timed squeezes of both grip and pinch and is adjustable to all sizes of hand and degrees of hand deformity. Results obtained with the system were found to be reproducible, and the rigid device was acceptable to a group of patients with arthritic hands. In rheumatoid arthritis, there is a marked reduction in maximum grip and pinch strength, together with a prolongation of the time taken to reach this maximum, and increased fatigue. The limitations of grip strength as a measure of function of the hand are discussed.

Clinical and electromyographical course of sciatica: prognostic study of 41 cases, Negrin P, Fardin P.

Electromyogr Clin Neurophysiol 1987;27:125-127
Abstract: The study of the clinical and EMGraphical course of patients with sciatica may help us to decide between a simple symptomatic treatment and an admission to hospital for neuroradiological tests and possible surgery. 41 patients with acute lumbosciatalgia and EMGraphically proven monoradicular denervation were studied: the root affected was L5 in 39 cases (78%), L4 in 7 cases and S1 in 2 cases. 19 of these cases were then submitted to surgical treatment of disc protrusion removal, the other 22 were treated medically. 3 to 8 years later, the following parameters were tested: pain, motor impairment, EMG denervation and degree of patient’s subjective judgment. We concluded that urgent hospital admission is indicated only in the case of severe and/or recent (within 1 month) paralysis or in the case of intolerable painful symptomatology. The diagnostic and prognostic role of EMG is hence confirmed: this examination yields information on the identity of the root involved, the severity of the denervation, its course and the degree of final improvement expected.

The use of major and minor therapy forms in
Australian chiropractic practice, Leboeuf, C, Patrick, K.

Journal of the Australian Chiropractic Association, 1987;17:109-11.
A survey of Australian chiropractors showed that most use five major
chiropractic techniques (Diversified, Sacro-Occipital technique, Gonstead,
Nimmo and Applied Kinesiology). High velocity adjustive techniques
(Diversified and Gonstead) were the most commonly reported major core
techniques. Predominantly low velocity manual techniques such as Applied
Kinesiology, Sacro-Occipital technique and Nimmo were most commonly reported as minor core techniques. Most employ adjunctive therapies, mainly nutrition, extremity techniques and exercise.

The relationship of knee and ankle weakness to falls in nursing home residents, Whipple, R, Wolfson, L, Amerman, P.

J Am Geriatr Soc, 1987;35:329-32
A study of nursing home residents with a history of falling found that muscle force and isokinetic power were significantly decreased in knee flexors (quadriceps) and extensors (hamstrings), and ankle dorsiflexors (tibialis anterior) and plantar flexors (gastrocnemius and soleus). Dorsiflexors were particularly weak in fallers, suggesting that they are an important factor contributing to balance. Of particular interest was ankle flexor and extensor strength because these muscles are linked to balance impairment in older adults with a history of falling. Strength training and other treatments that may improve muscle function in these areas may enhance balance in balance-impaired older adults.

Piriformis syndrome: pathogenesis, diagnosis, and treatment, Steiner C, Staubs C, Ganon M, Buhlinger C.

J Am Osteopath Assoc 1987;87:318-323
The failure of conservative treatment for lumbosacral disk disorders often leads to surgery. If the pain is produced by sciatic neuritis rather than sciatic radiculitis, operative treatment may be unavailing. This paper describes the mechanism by which piriformis syndrome causes sciatic neuritis and differentiates neuritis from radiculitis, the treatment of which often results in the “failed disk syndrome.” Sciatic neuritis is now believed to result from irritation of the sciatic nerve sheath, which is caused by biochemical agents released from an inflamed piriformis muscle where the two structures meet at the greater sciatic foramen. The symptoms of piriformis syndrome present almost identically to lumbar disk syndrome, except for the consistent absence of true neurologic findings. Diagnosis is accomplished by palpation of myofascial trigger points within the piriformis muscle. Computed tomography, myelography, roentgenography, and electromyography are of limited diagnostic value. Treatment, which consists of a conservative approach employing local anesthetics and osteopathic manipulation, is without significant risk. Reducing muscle spasm, restoring joint motion, and keeping the patient ambulatory and in motion are keys to successful treatment.

Correlation of objective measure of trunk motion and muscle function with low-back disability ratings, Triano, J, Schultz, A

Spine, 1987;12:561-5
Abstract: A study was undertaken to examine relations among some objective and subjective measures of low-back-related disability in a group of 41 low-back pain patients and in seven pain-free control subjects. Subjective measures of disability were obtained by Oswestry patient questionnaires. Oswestry disability score related significantly (P less than 0.001) to presence or absence of relaxation in back muscles during flexion. Mean trunk strength ratios were inversely related to disability score (P less than .05), and trunk mobility was meaningfully reduced (P less than .01). Despite loss of motion, a large enough excursion was observed to predict presence of back muscle relaxation. These findings imply that myoelectric signal levels, trunk strength ratios, and ranges of trunk motion may be used as objective indicators of low-back pain disability.

Comment: The findings in this study imply that muscle function, as measured by EMG, MMT, and ranges of trunk motion may be used as objective indicators of low-back pain disability.

Clinical biomechanical correlates for cervical function: Part II. A myoelectric study, Vorro J, Johnston W.

J Am Osteopath Assoc 1987;87:353-367

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