Relative effectiveness and adverse effects of cervical manipulation, mobilisation and the activator instrument in patients with sub-acute non-specific neck pain: results from a stopped randomised trial

Gemmell, Hugh; Miller, Peter

doi:10.1186/1746-1340-18-20

Cited by 30 publications

(31 citation statements)

References 86 publications

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“…23 The device used by Sobador A provided torsion pressure to facilitate the manipulative process; such devices are used by conventional manual therapy practitioners. 24 Marking a patient is also a manual therapy practice to help focus the treatment. 25 Sobador C used poultices; although the poultice techniques are traditional, Lewit mentions it as a substitute for electric muscle stimulation in conventional manual therapy.…”

Section: Discussionmentioning

confidence: 99%

Manual Therapy Practices of Sobadores in North Carolina

Graham¹,

Sandberg

Quandt

et al. 2016

The Journal of Alternative and Complementary Medicine

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Objectives: This analysis provides a description of the manual-therapy elements of sobadores practicing in North Carolina, using videotapes of patient treatment sessions. Design: Three sobadores allowed the video recording of eight patient treatment sessions (one each for two sobadores, six for the third sobador). Each of the recordings was reviewed by an experienced chiropractor who recorded the frequencies of seven defined manual-therapy elements: (1) treatment time; (2) patient position on treatment surface; (3) patient body part contacted by the sobador; (4) sobador examination methods; (5) primary treatment processes; (6) sobador body part area referencing patient; and (7) adjunctive treatment processes. Results: The range of treatment time of 9-30 min was similar to the treatment spectra that combine techniques used by conventional massage and manipulative practitioners. The patient positions on the treatment surface were not extraordinary, given the wide variety of treatment processes used, and indicated the sobadores treat patients in multiple positions. The patient body part contacted by the sobadores indicated that they were treating each of the major parts of the musculoskeletal system. Basic palpation dominated the sobadores' examination methods. The sobadores' primary treatment processes included significant variety, but rubbing was the dominant practice. The hands were the sobador body area that most often made contact with the patient. They all used lubricants. Conclusions: Sobadores' methods are similar to those of other manual-therapy practitioners. Additional study of videorecorded sobador practices is needed. Video-recorded practice of other traditional and conventional manual therapies for comparative analysis will help delineate the specific similarities and differences among the manual therapies.

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Section: Discussionmentioning

confidence: 99%

Manual Therapy Practices of Sobadores in North Carolina

Graham¹,

Sandberg

Quandt

et al. 2016

The Journal of Alternative and Complementary Medicine

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“…Clinical trials have also found minor AEs after patients undergoing a trial of SMT [7-12]. Some studies have looked at cervical SMT and the relationship of this care to AEs and clinical outcome measures.…”

Section: Introductionmentioning

confidence: 99%

Symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care: A prospective, multicenter, cohort study

Eriksen

Rochester²,

Hurwitz

2011

BMC Musculoskelet Disord

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BackgroundObservational studies have previously shown that adverse events following manipulation to the neck and/or back are relatively common, although these reactions tend to be mild in intensity and self-limiting. However, no prospective study has examined the incidence of adverse reactions following spinal adjustments using upper cervical techniques, and the impact of this care on clinical outcomes.MethodsConsecutive new patients from the offices of 83 chiropractors were recruited for this practice-based study. Clinical outcome measures included 1) Neck pain disability index (100-point scale), 2) Oswestry back pain index (100-point scale), 3) 11-point numerical rating scale (NRS) for neck, headache, midback, and low back pain, 4) treatment satisfaction, and 5) Symptomatic Reactions (SR). Data were collected at baseline, and after approximately 2 weeks of care. A patient reaching sub-clinical status for pain and disability was defined as a follow-up score <3 NRS and <10%, respectively. A SR is defined as a new complaint not present at baseline or a worsening of the presenting complaint by >30% based on an 11-point numeric rating scale occurring <24 hours after any upper cervical procedure.ResultsA total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0%) patients had SRs meeting the accepted definition. Intense SR (NRS ≥8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p <0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event.ConclusionsUpper cervical chiropractic care may have a fairly common occurrence of mild intensity SRs short in duration (<24 hours), and rarely severe in intensity; however, outcome assessments were significantly improved with less than 3 weeks of care with a high level of patient satisfaction. Although our findings need to be confirmed in subsequent randomized studies for definitive risk-benefit assessment, the preliminary data shows that the benefits of upper cervical chiropractic care may outweigh the potential risks.

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“…Effectiveness of manipulation and/or mobilization in isolation for acute or chronic non-speci ic neck pain remains inconclusive [42,44,45]. Our objective was to identify the independent and unilateral Mulligan clinical effect as a monotherapy, without any simultaneously conservative method.…”

Section: Discussionmentioning

confidence: 99%

The short and mid-term effects of Mulligan concept in patients with chronic mechanical neck pain

Zemadanis¹

2018

J Nov Physiother Rehabil

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Background: Mechanical chronic neck pain is very common musculoskeletal dysfunction among people, manifesting one or more pain-induced movements and disability impairments. Clinical guidelines suggest passive cervical mobilization and thoracic manipulation as manual therapy interventions. Mulligan concept has positive effect in patients with lumbar and thoracic spine mechanical chronic pain. Study objective was to investigate possible clinical effects of Mulligan techniques in patients with cervical pain according to pain and disability status.Methods: forty participants diagnosed with mechanical chronic cervical pain, randomly assigned into experimental and control group. NAG, SNAG and self-SNAG joint mobilization in a nine-sessions protocol implemented to the study group, while SHAM-Mulligan techniques applied to control group. Self-reported questionnaires Numeric Pain Rating scale (NPRT) and Neck Disability Index (NDI) were used for the measurement of pain and disability levels respectively. Possible Interactions among Factors (TIME X GROUP) and simple effects in three-time measurements of pre, post and one-month follow-up concerning NDI and NPRS variables, were detected with Mixed-ANOVA test.Results: Baseline scores of pain and disability resulted in no differences between groups. A signifi cant Group and Time factors interaction founded and simple main effects analysis showed that Mulligan concept-group had signifi cant improvement in post-intervention NPRT and NDI scores (p<.001), compared to baseline scores. Follow-up also differed compared to post-treatment score (p<.001). SHAM-Mulligan control group had no signifi cant differences in dependent variables at any level of TIME factor (p>.001). Signifi cant differences were found between groups according to second and third measurement phase (p<.001). Conclusion:Our fi ndings suggest that Mulligan concept techniques improve symptoms of pain and disability in chronic mechanical neck pain patients in short and mid-term effect level.Summary: mobilization techniques of SNAGs, NAGS and self-SNAGs reduces pain and improve function in patients with mechanical neck pain. Taken into consideration the safety and simplicity of application, future studies are encourage to examine the underline mechanism of action.

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Relative effectiveness and adverse effects of cervical manipulation, mobilisation and the activator instrument in patients with sub-acute non-specific neck pain: results from a stopped randomised trial

Cited by 30 publications

References 86 publications

Manual Therapy Practices of Sobadores in North Carolina

Manual Therapy Practices of Sobadores in North Carolina

Symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care: A prospective, multicenter, cohort study

The short and mid-term effects of Mulligan concept in patients with chronic mechanical neck pain

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