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Winter/Spring 2007


Head Repositioning Errors in Normal Student Volunteers: A Possible Tool to Assess the Neck’s Neuromuscular System

AUTHORS: Edward Owens, Jr., D.C., M.S.; Charles Henderson, D.C.; Ram Gudavalli, Ph.D.; Joel Pickar, D.C.  

Joint pain can interfere with the ability to position body parts accurately. We tested whether repositioning errors could be induced in a normal population by contraction of the neck muscles. In the study, volunteers free of neck problems found a comfortable neutral head posture with eyes closed. They deconditioned their cervical muscles by moving their heads in either flexion/extension or lateral flexion and then attempted to return to the same starting position. Two conditioning sequences were interspersed within the task: hold the head in an extended or laterally flexed position for 10 seconds; or hold a 70 percent maximum voluntary contraction for 10 seconds. The difference between the initial and final head orientation was calculated in three planes. Forty-eight chiropractic students participated. During the neck extension test, actively contracting the posterior neck muscles evoked an undershoot of the target position by 2.1° (P<0.001). No differences in repositioning were found during the lateral flexion test. The results suggest that the recent cervical paraspinal muscle contraction can influence head repositioning in flexion/extension. This is the first time that muscle history has been shown to influence proprioceptive accuracy in the human neck. This finding may be used to elucidate the mechanism behind repositioning errors seen in people with neck pain.

A Randomized Clinical Trial and Subgroup Analysis to Compare Flexion–Distraction with Active Exercise for Chronic Low Back Pain.

AUTHORS: Ram Gudavalli, Ph.D.; Jerrilyn Cambron, D.C., M.P.H., Ph.D.; Marion McGregor, D.C., Ph.D.; James Jedlicka, D.C., et al.  

Flexion distraction (FD) is a commonly used form of chiropractic care. No previous clinical trial has assessed its effectiveness. This study compared two treatment protocols. The objective was to compare the outcome of chiropractic FD procedures to an active trunk exercise protocol (ATEP) performed by physical therapists. A randomized clinical trial study design was used. A 100-mm visual analogue scale (VAS) for perceived pain, the Roland Morris (RM) Questionnaire for low back function, and the SF-36 for overall health status served as primary outcome measures. The FD intervention consisted of the application of flexion and traction applied to the low back, using a speciallydesigned table. The ATEP intervention included exercises, modalities and cardiovascular training. Study patients perceived significantly less pain and better function after intervention, regardless of which group they were in (P<0.01). Subjects in the FD group had greater relief from pain than those in the exercise program (P=0.01). Subjects categorized as chronic improved most with the FD protocol. Subjects with recurrent pain and moderate to severe symptoms improved most with exercise. Patients with radiculopathy did better with FD. There were no significant differences between groups on the RM and SF-36 outcome measures. Overall, FD provided more pain relief than active exercise; however, these results varied based on stratification of patients with and without radiculopathy and recurrent symptoms.

The Palmer Center for Chiropractic Research is located on Palmer’s Davenport Campus in the William and Jo Harris Building.
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