March 1994 Volume 38, No.1

March 1994 Volume 38, No.1

The purpose of this paper is to asses the reliability, validity and usefulness of three outcome measures: cervical ranges of motion, sagittal neck muscle strength and presence or absence of the flexion relaxation phenomenonn (FRP) in the neck. The literature search included the Index Medicus and computerized database of MEDLINE for relevant material. Articles were selected if they contained primary data on neck range of motion, sagittal muscle strength and FRP. The results of 59 articles and 2 textbooks were analyzed. Normative values of cervical ROM have been reported in healthy subjects ranging in age from 18 to 74 years. The extent of degrees of motion lost per year did not differ between male or female subjects, but females started with higher degrees of active range of motion, which they maintained throughout life. Instrumented methods of recording muscle strength have included strain gauge dynamometers and modified sphygmomanometers. Parameters such as gender, age and stature were also observed to have important effects on muscle strength. The ratio of extension to flexion maximum isometric peak force has been estimated to range between 1.40-1.70 in normal subjects. Therefore, the extensor muscles of the neck are approximately 40% stronger than the neck flexor muscles. Evidence suggested that neck pain sufferers have weaker neck flexors than normal subjects. The FRP refers to the absence of myoelectrical activity in extensor muscles upon full forward flexion and has been documented in the cervical spine of asymptomatic subjects. In conclusion, inclinometric methods used for measurements of cervical range of motion were found to be safe, effective and reliable. The Cervical Range of Motion Device appeared to be well suited for clinical practice. The ratio of cervical extension-flexion maximum isometric voluntary contraction has been determined in asymptomatic subjects. The presence of the FRP in the neck has also been observed in normals. Future study is needed to investigate the functional limitations relating to acute and chronic mechanical neck pain which account for a portion of total neck disability. (JCCA 1994; 38(1):32-40)

cervical vertebrae, objective measurement, neck strength and mobility, range of motion, myoelectric signal, flexion relaxation

March 1994 Volume 38, No.1

The relative movements between vertebral bodies T10 and T11, and T11 and T12 were measured during clinical-type SMTs to T11 in unembalmed post-rigor human cadavers, using embedded stainless steel bone pins and high speed cinematography. Significant relative movements between target and adjacent vertebrae occurred primarily in sagittal and axial rotation during the thrust phases of the SMTs. The relative positions of the vertabral bodies were compared at similar force levels, before and after the rapid thrust phases. The sagittal angles between T11 and T12 following the SMTs, were significantly different from their pre-thrust values. Two non-invasive methods (surface markers and uni-axial accelerometers) were compared to the invasive bone pins, in order to assess their suitability to accurately measure posterior-anterior translation. The results showed that both non-invasive techniques significantly underestimated the absolute movements of all vertebral bodies during the SMTs. The relative posterior-anterior translations using the non-invasive techniques however, were not significantly different from those determined from the bone pins. (JCCA 1994; 38(1):11-24)

biomechanics, spinal manipulative therapy, SMT, vertebral movements

La cinématographie ultra-rapide et les aiguilles effractives en acier inoxydable ont été utilisées sur des cadavres pour mesurer les mouvements relatifs entre les vertèbres D-10-D-11 et D-11-D-12 lors de manipulations vertébrales sous D-11. La dépouille humaine était en phase post-rigidité et non-embaumée. L’examen a révélé durant l’ajustement des mouvements relatifs importants entre l’endroit visé et la vertèbre adjacente, principalement sur le plan sagittal et une rotation axiale. La position des corps vertébraux soumis à des ajustements de force égale comprend: avant et après l’ajustement. Les angles sagittaux entre les vertèbres D-11 et D-12, suite aux TMV, se révélèrent passablement différents de ce qu’ils étaient avant le test. Deux méthodes non-invasives (marqueurs de surface et accéléromètres uniaxials) furent comparées aux aiguilles invasives de façon à évaluer leur aptitude à mesurer efficacement le transfert postérieur-antérieur. Les résultats ont indiqué que les deux techniques non-invasives ont largement sous-estimé les mouvements absolus de tous les corps vertébraux pendant les TMV. Les transferts relatifs postéro-antérieurs mesurés au moyen de techniques non-invasives ne démontraient pas de différences significatives par rapport aux transferts obtenus au moyen des aiguilles invasives. (JCCA 1994; 38(1): 11-24)

biomécaniques, techniques de manipulation vertébrale, (TMV), mouvements de vertèbres

March 1994 Volume 38, No.1

The Canadian Memorial Chiropractic College (CMCC) or its agents, have been seeking some form of university affiliation for at least 30 years, yet to date those efforts have been fruitless. It has been said that one's success is not measured by the position you have attained - but by the obstacles you have had to overcome to get there. CMCC has run into many stumbling blocks on the road to amalgamation. This triad of papers, Part I (JCCA 1992; 36(1):33-37 and Part III to follow at a later date, will endeavour to describe and document those barriers and the resourceful attempts that have been marshalled to surmount them. Part I, 1945 to 1969, concentrates on the first recorded proposals, emanating from the Western Divisions of the Canadian Chiropractic Association (CCA). Part II, 1969 to 1988, will outline the scattergun method that was used to approach numerous institutions, primarily in Ontario. Part III, 1988 to 1991, will focus on an account of the push for union with the University of Victoria, in British Columbia (U Vic). (JCCA 1994; 38(1):41-54)

CMCC, affiliation, university

March 1994 Volume 38, No.1

The case describes a female patient with squamous cell carcinoma of the lung who initially presented with mechanical upper-back and neck pain. She had been successfully treated with spinal manipulation for a similar complaint one year earlier, a factor that decreased the suspicion of pathological process on her second presentation. Serious disease as the cause of back pain must be considered in cases with certain historical factors, or when the patient fails to respond to treatment for mechanical back pain. (JCCA 1994; 38(1):25-31)

lung carcinoma, back pain, manipulation

Ce cas décrit une patiente atteint de carcinome pulmonaire à cellules squameuses, s’étant d’abord présenté par un problème de douleur mécanique dans la partie supérieure du dos ainsi que dans la région cervicale. Un an plus tôt, un problème semblable avait été réglé par des manipulations vertébrales; résultat qui cette fois-ci, nous laisse penser plutôt à une rechute qu’à une pathologie. Lorsque l’anamnèse le suggère ou que le patient ne répond pas bien à l’approche conservatrice, la possibilité d’une pathologie sous-jacente à manifestation symptomatique devra être considérée. (JCCA 1994; 38(1): 25-31)