PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY

The Audible Pop from Thoracic Spine Thrust Manipulation and Its Relation to Short-Term Outcomes in Patients with Neck Pain

Joshua A. Cleland, PT, PhD, OCS, FAAOMPT, Timothy W. Flynn, PT, PhD, OCS, FAAOMPT, John D. Childs, PT, PhD, MBA, OCS, FAAOMPT, Sarah Eberhart, PT, DPT

Abstract: Clinicians routinely consider the success of a thrust manipulation technique based on the presence or absence of an audible pop despite the lack of evidence suggesting that this pop is associated with improved outcomes. The purpose of this study was to determine the relationship between the number of audible pops with thoracic spinal manipulation and improvement in pain and function in patients with mechanical neck pain. In this prospective cohort study, 78 patients referred to physical therapy with mechanical neck pain underwent a standardized examination and thoracic spine manipulation treatment protocol. All patients were treated with a total of 6 thrust manipulation techniques directed to the thoracic spine followed by a basic cervical range of motion exercise. The treating clinician recorded the presence or absence of a pop during each manipulation. Outcomes were assessed at a 2-4 day follow-up with an 11-point numeric pain rating (NPRS), the Neck Disability Index, the patient Global Rating of Change (GROC), and measurements of cervical range of motion (CROM). The relationship between the number of pops and change scores for pain, disability, and CROM was first examined using Pearson correlation coefficients. Individuals were then categorized as having received < or = 3 or >3 pops. Repeated measures analyses of variance were used to examine whether achievement of >3 pops resulted in improved outcome. Seventy-eight patients with a mean age of 42 (SD 11.3) years participated in the study. Pearson correlation coefficients revealed no significant correlation existed between the number of pops and outcomes with the exception of 3 of the 6 CROM measurements, which were inversely related. There was no significant interaction for group X time for any of the dependent measures (P>0.05). The odds ratio for patients experiencing dramatic improvement was in favor of the group experiencing < or = 3 pops but this was not clinically meaningful (1.3: 95% CI 0.46, 3.7). The results of this analysis provide preliminary evidence for the hypothesis that there is no relationship between the number of audible pops during thoracic spine thrust manipulation and clinically meaningful improvements in pain, disability, or CROM in patients with mechanical neck pain. Additionally, a greater number of audible pops experienced was not associated with a dramatic improvement with manipulation treatment.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 3 (2007), 143-154

Influential Variables Associated with Outcomes in Patients with Cervicogenic Headache

Robert Fleming, PT, DPT, OCS, COMT, Sara Forsythe, PT, DPT, Chad Cook, PT, PhD, MBA, OCS, FAAOMPT

Abstract: Cervicogenic headache (CGH) is a common sequela of upper cervical dysfunction with a significant impact on patients. Diagnosis and treatment have been well validated; however, few studies have described characteristics of patients that are associated with outcomes of physical therapy treatment of this disorder. A retrospective chart review of patient data was performed on a cohort of 44 patients with CGH. Patients had undergone a standardized physical therapy treatment approach that included spinal mobilization/manipulation and therapeutic exercise, and outcomes of treatment were determined by quantification of changes in headache pain intensity, headache frequency, and self-reported function. Multiple regression analysis was utilized to determine the relationship between a variety of patient- specific variables and these outcome measures. Increased patient age, provocation or relief of headache with movement, and being gainfully employed were all patient factors that were found to be significantly (P<0.05) related to improved outcomes.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 3 (2007), 155-164

A History of Manipulative Therapy

Erland Pettman, PT, MCSP, MCPA, FCAMT, COMT

Abstract: Manipulative therapy has known a parallel development throughout many parts of the world. The earliest historical reference to the practice of manipulative therapy in Europe dates back to 400 BCE. Over the centuries, manipulative interventions have fallen in and out of favor with the medical profession. Manipulative therapy also was initially the mainstay of the two leading alternative health care systems, osteopathy and chiropractic, both founded in the latter part of the 19th century in response to shortcomings in allopathic medicine. With medical and osteopathic physicians initially instrumental in introducing manipulative therapy to the profession of physical therapy, physical therapists have since then provided strong contributions to the field, thereby solidifying the profession's claim to have manipulative therapy within in its legally regulated scope of practice.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 3 (2007), 165-174

Abstracts: AAOMPT Conference 2007

The following abstracts are to be presented at the 13th annual meeting of the American Academy of Orthopaedic Manual Physical Therapists held in St Louis, Missouri from October 19Ð21, 2007. Presentations are either by poster or platform. These abstracts were peer-reviewed by an AAOMPT committee prior to acceptance for presentation at the AAOMPT conference. However, inclusion of an abstract in this supplement does not constitute a peer-reviewed journal publication. The publication of abstracts alerts readers to research that is presently being conducted. It is hoped that the research presented here in brief will eventually be submitted as full-length manuscripts for review and potential publication.
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Positive Cervical Artery Testing in a Patient with Chronic Whiplash Syndrome: Clinical Decision Making in the Presence of Diagnostic Uncertainty

David L. Graziano, PT, DPT, MTC, Wanda Nitsch, PT, PhD, MTC, Peter A. Huijbregts, PT, DPT, OCS, FAAOMPT, FCAMT

Abstract: This case report describes the diagnosis and management of a 43-year-old female patient who had sustained an injury to her neck in a motor-vehicle accident two years earlier. The major symptoms described by the patient included headache and neck pain, but history and examination also revealed signs and symptoms potentially indicative of cervical artery compromise. Physical therapy management initially consisted of soft tissue and non-thrust joint manipulation of the lower cervical and thoracic spine, specific exercise prescription, and superficial heat. Cervical vascular compromise was re-evaluated by way of the sustained extension-rotation test. When at the fifth visit this test no longer produced symptoms potentially indicative of vascular compromise, upper cervical diagnosis and management consisting of soft tissue and non-thrust joint manipulation was added. A positive outcome was achieved both at the impairment level and with regard to limitations in activities, the latter including increased performance at work, a return to previous reading activities, improved length and quality of sleep, and greater comfort while driving. At discharge, the patient reported only occasional pain and mild limita- tions in activities. This report describes the positive outcomes in a patient with chronic whiplash syn- drome; however, its main emphasis lies in the discussion and critical evaluation of clinical reasoning in the presence of diagnostic uncertainty with regard to cervical artery compromise.
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Letters to the editor

[No abstract available]
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WCPT Awards for Brian Mulligan and Robin McKenzie

Duncan Reid, MHSc (Hons) PGD (Manip Physiotherapy), Dip MT, Dip Phys, BSc, MNZCP, Peter A. Huijbregts, PT, DPT, OCS, FAAOMPT, FCAMT

During the recent World Confederation for Physical Therapy (WCPT) conference in Vancouver, British Columbia, two physical therapists from New Zealand were honoured with the WCPT International Service to the Profession Award. This award is presented at most once every four years to physical therapists that have made an exceptional contribution to the profession at the international or regional level by way of excellence in the areas of practice, education, research, or administration and policy development [No abstract available].
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