Rogers R G
J Manipulative Physiol Ther. 1997 Feb;20(2):80-5.
To determine whether spinal manipulation as an isolated intervention has any effect on proprioception-dependent performance of subjects with chronic neck pain, compared with effects achieved through stretching exercises.
Matched, nonrandomized, controlled trial.
Private chiropractic clinic.
Twenty subjects with chronic (daily, > or = 4 months) neck pain. Volunteers were recruited from a pool of patients visiting the clinic or from those referred by informed clinicians.
Half of the subjects received six sessions of high-velocity, low-amplitude manipulation to the cervical and upper thoracic regions during a 3-4 wk period. The other half were instructed in stretching exercises for the cervicothoracic muscles, to be performed in two unsupervised sessions daily over the same time period.
Pain levels were assessed at baseline and at each of six follow-up sessions using a 100-mm visual analogue scale. The abilities of the blindfolded subjects to reproduce a neutral head position after moving the head and neck through various planes of motion was the method used to estimate proprioceptive acuity. This was done with the use of a laser pointer affixed to the top of an adjustable cap. Points were marked and measured on a target before and after head movement and repositioning.
Subjects receiving manipulation demonstrated a mean reduction in visual analogue scores of 44%, along with a 41% improvement in mean scores for the head repositioning skill. In comparison, a 9% mean reduction in visual analogue scores and a 12% improvement in head repositioning scores was observed for the stretching group. The difference in the outcomes of the head repositioning skill scores was significant (p < or = .05).
The results suggest a possible effect of manipulation on proprioception in subjects with chronic neck pain. The small sample size, lack of true randomization and lack of blinding of the examiner are factors that weaken these findings. Larger, more controlled studies are needed to determine what specific effects manipulation may have on the function of proprioception.
与拉伸锻炼的效果相比，确定作为一种单独干预措施的脊柱推拿对慢性颈痛患者本体感觉相关表现是否有任何影响。
匹配、非随机、对照试验。
私人脊椎按摩诊所。
20名患有慢性（每日发作，≥4个月）颈痛的患者。志愿者从到诊所就诊的患者群体或由知情临床医生转诊的患者中招募。
一半受试者在3 - 4周内接受6次针对颈椎和上胸部区域的高速低幅推拿。另一半受试者接受颈胸肌拉伸锻炼指导，在同一时间段内每天进行两次无人监督的锻炼。
使用100毫米视觉模拟量表在基线和六个随访阶段分别评估疼痛程度。通过让蒙眼受试者在头部和颈部在各个运动平面移动后重现中立头部位置的能力来估计本体感觉敏锐度。这是通过将激光指示器固定在可调节帽子顶部来完成的。在头部移动和重新定位前后在目标上标记并测量点。
接受推拿的受试者视觉模拟评分平均降低44%，头部重新定位技能平均得分提高41%。相比之下，拉伸组视觉模拟评分平均降低9%，头部重新定位评分提高12%。头部重新定位技能评分结果的差异具有统计学意义（p≤0.05）。
结果表明推拿可能对慢性颈痛患者的本体感觉有影响。样本量小、缺乏真正的随机化以及检查者未设盲是削弱这些研究结果的因素。需要更大规模、更具对照性的研究来确定推拿对本体感觉功能可能产生的具体影响。
