Klein P, Broers C, Feipel V, Salvia P, Van Geyt B, Dugailly P M, Rooze M
Research Unit for Manual Therapies, Free University of Brussels, 50 Avenue Franklin Roosevelt CP168, 1050 Brussels, Belgium.
Clin Biomech (Bristol). 2003 Nov;18(9):827-31. doi: 10.1016/s0268-0033(03)00170-0.
Determination of the three-dimensional kinematics of the head relative to the upper trunk obtained during a manipulation applied on two different cervical levels and on both sides.
Descriptive study performed on 14 asymptomatic volunteers. The range of motion was measured by a 3D electrogoniometer during manipulation executed by the same practitioner.
Spinal manipulative therapy is a common treatment approach in patients suffering from some spinal disorders. Complications exist; they are thought to be related to the force applied by the practitioner and the range of spinal motion obtained during the manipulation. Yet, little is known about cervical spine motion during manipulation.
Three dimensional electrogoniometry using a 6 degree-of-freedom spatial linkage fixed between the head and the upper trunk was used to record the pattern of motion and the amplitudes obtained during a manipulation on two cervical levels (C3 and C5) and on left and right sides. On single practitioner applied the same technique to all subjects in a seated position.
The side and the spinal level manipulated did not influence 3D ranges of motion. The mean ranges of motion obtained were 30 degrees axial rotation, 46 degrees lateral bending and 2 degrees flexion. A significant difference of the flexion-extension range existed between manipulations with and without audible release. Axial rotation and lateral bending ranges were correlated. Except for lateral bending which was close to active range, the motion ranges obtained during manipulation were well below active range of motion reported in literature.
The results of this study suggest that for the kind of manipulation applied, maximal amplitude between head and trunk does not exceed physiological active range of motion. The amplitude for rotation, which is generally assumed to involve greatest risks for negative side effects, is significantly lower than during active motion. As the study was performed with one practitioner, this result may only be generalized with care.
In spinal manipulative therapy, extreme range of motion as the result of the forces applied is generally believed to represent a major risk for negative side effects, especially with regard to the cervical spine. With a multiple component technique, amplitudes between head and upper trunk were shown not to differ significantly with regard to the side nor to the spinal level. Recorded ranges of motion did not exceed those reported for active motion in literature.
确定在两个不同颈椎节段双侧进行手法操作时头部相对于上躯干的三维运动学情况。
对14名无症状志愿者进行描述性研究。由同一名从业者进行手法操作时，使用三维电子测角仪测量运动范围。
脊柱手法治疗是患有某些脊柱疾病患者的常见治疗方法。存在并发症；人们认为这些并发症与从业者施加的力以及手法操作过程中获得的脊柱运动范围有关。然而，对于手法操作过程中颈椎的运动情况知之甚少。
使用固定在头部和上躯干之间的六自由度空间连杆进行三维电子测角，以记录在两个颈椎节段（C3和C5）双侧进行手法操作时的运动模式和获得的幅度。由一名从业者对所有坐位受试者应用相同技术。
手法操作的侧别和脊柱节段不影响三维运动范围。获得的平均运动范围为轴向旋转30度、侧屈46度和前屈2度。有可闻释放音和无可闻释放音的手法操作之间，屈伸范围存在显著差异。轴向旋转和侧屈范围相关。除侧屈接近主动运动范围外，手法操作过程中获得的运动范围远低于文献报道的主动运动范围。
本研究结果表明，对于所应用的这种手法操作，头部与躯干之间的最大幅度未超过生理主动运动范围。通常认为旋转幅度涉及负面副作用风险最大，其显著低于主动运动时的幅度。由于本研究由一名从业者进行，该结果推广时需谨慎。
在脊柱手法治疗中，一般认为由于施加的力导致的极端运动范围是负面副作用的主要风险，尤其是对于颈椎。采用多分量技术，头部与上躯干之间的幅度在侧别和脊柱节段方面无显著差异。记录的运动范围未超过文献报道的主动运动范围。
