Salem Walid, Klein Paul
Department of Osteopathy, Faculty of Motor Sciences, Université libre de Bruxelles(ULB), 808 route de Lennik, 1070 Brussels, Belgium.
Man Ther. 2013 Aug;18(4):321-6. doi: 10.1016/j.math.2012.11.007. Epub 2013 Jan 21.
Segmental range of motion (ROM) during high-velocity manipulative spinal treatment is generally considered an important factor for the risk of adverse side effects, especially in the cervical spine region. Among the many techniques reported, the so-called multiple-component technique (MCT) is increasingly recommended. Such a technique is assumed to induce a relatively low three-dimensional (3D) segmental ROM compared with other techniques. The aims of our study are to quantify the 3D segmental ROM and to determine the pattern of motion between cervical vertebrae during the pre-manipulative position at the C4-C5 level. Ten healthy volunteers participated in this study. Two CT scans were conducted: one in a neutral position and the other in the pre-manipulative positioning. The manipulation using MCT was carried out by a skilled practitioner. During positioning, the head was rotated to the left and bent laterally to the right, and the upper cervical spine was rotated to the left and bent laterally to the right. In contrast, the lower cervical spine underwent right rotation and was bent laterally to the right. Segmental ROM was lower than the values obtained during active physiological rotation (P < 0.05). This study provides new insight into the 3D kinematics of the cervical spine during manipulation. An unexpected mechanism of counter-rotation was identified at the lower cervical levels and could represent a valuable and convenient way for precisely focussing on the level for manipulation.
在高速脊柱手法治疗过程中，节段活动度（ROM）通常被认为是出现不良副作用风险的一个重要因素，尤其是在颈椎区域。在众多已报道的技术中，所谓的多成分技术（MCT）越来越受到推荐。与其他技术相比，这种技术被认为能诱发相对较低的三维（3D）节段活动度。我们研究的目的是量化3D节段活动度，并确定在C4 - C5水平手法操作前的体位下颈椎椎体之间的运动模式。十名健康志愿者参与了本研究。进行了两次CT扫描：一次在中立位，另一次在手法操作前的体位。使用MCT的手法操作由一名熟练的从业者进行。在体位摆放过程中，头部向左旋转并向右侧弯，上颈椎向左旋转并向右侧弯。相比之下，下颈椎进行了右旋并向右侧弯。节段活动度低于主动生理旋转时获得的值（P < 0.05）。本研究为手法操作过程中颈椎的3D运动学提供了新的见解。在下颈椎水平发现了一种意外的反向旋转机制，这可能是一种精确聚焦于手法操作水平的有价值且便捷的方式。
