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Research Interests: Rehabilitation, Complementary and Alternative Medicine, Chiropractic, Manual Therapy, Medicine, and 15 morePhysical Medicine and Rehabilitation, Low back pain, Humans, Posture, Clinical Sciences, Mechanical Stress, Prognosis, Neuromuscular diseases, Soft Tissue Injuries, Pilot Projects, Clinical Protocols, Spinal manipulation, Biomechanical Phenomena, guidelines as topic, and Spinal diseases
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Research Interests: Biophysics, Orthodontics, Complementary and Alternative Medicine, Chiropractic, Medicine, and 15 moreSoftware, Humans, Cervical Vertebrae, Clinical Sciences, Intraclass Correlation Coefficient, Radiography, Analysis of Variance, Reproducibility of Results, Clinical Competence, Sensitivity and Specificity, Thoracic Vertebrae, Confidence Interval, lumbar vertebrae, Random Allocation, and Lumbosacral Region
Objective: To evaluate sensorimotor integration and skill-related physical fitness components for participants with forward head posture (FHP) compared with strictly matched controls with normal head alignment. Material and Methods: We... more
Objective: To evaluate sensorimotor integration and skill-related physical fitness components for participants with forward head posture (FHP) compared with strictly matched controls with normal head alignment. Material and Methods: We measured FHP, sensorimotor processing, and skill-related physical fitness variables in 50 participants with FHP and in 50 participants matched for age, gender, and body mass index with normal FHP, defined as having a craniovertebral angle >55°. Sensorimotor processing and integration variables were: (1) amplitudes of the spinal N13, (2) brainstem P14, (3) parietal N20 and P27, and (4) frontal N30 potentials. The skill-related physical fitness variables selected for the study were (1) T-test agility, (2) leg power, (3) stork static balance test, and (4) Y-balance test. Results: There was a statistically significant difference between the FHP group and control group for the sensorimotor integration variable: frontal N30 potentials (P < .05). Additionally, between-group differences were found for the sensorimotor processing variables: amplitudes of spinal N13, brainstem P14, and parietal N20, and P27 (P < .05). Statistically significant differences between groups for the skill-related physical fitness variables were also identified: T-test agility, leg power, stork static balance test, and Y-balance test (P < .05). The magnitude of the craniovertebral angle showed a correlation with all measured variables (P < .05). Conclusion: College athletes with FHP exhibited altered sensorimotor processing and integration measurements and less efficient skill-related physical fitness compared with athletes with normal sagittal head posture alignment.
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Objective: To determine the state of knowledge relative to three-dimensional spinal coupled motion and to check the validity of currently accepted two-dimensional coupling as taught in chiropractic. Data collection: A hand search of... more
Objective: To determine the state of knowledge relative to three-dimensional spinal coupled motion and to check the validity of currently accepted two-dimensional coupling as taught in chiropractic. Data collection: A hand search of available reference texts and a computer search of literature from Index Medicus were collected with an emphasis on three-dimensional studies of human spinal movements. Results: Most postural movements result in complicated three-dimensional spinal coupling in six degrees of freedom. Previous spinal coupling results based upon two-dimensional radiographic studies are inadequate and inaccurate. It is important that chiropractic colleges and techniques use the three-dimensional spinal kinematics to update their curricula and advance chiropractic treatment procedures. Conclusion: Full three-dimensional investigations of spinal coupling patterns have shown that the vertebrae rotate and translate in all three axes and that previous theories of spinal coupling based upon two-dimensional studies are inaccurate and invalid. Postural rotations and translations, which are the main motions studied in spinal coupling research, and altered configurations of the normal sagittal plane curves are the cause of both normal and abnormal spinal coupling patterns in three dimensions. Chiropractic letter listings (such as PRS, ASRP, etc.) are outdated, incomplete, invalid representations of coupled segmental movements. Mechanical loading of the neuromusculoskeletal tissues plays a vital role in position, dynamics, proper growth, repair and symptoms. Future studies of spinal kinematics should study the postural translations of the skull and thorax for their associated coupling in three dimensions. Combined postural rotations and translations along with altered sagittal curvatures need to be studied for their associated coupling characteristics as well.
Research Interests: Photogrammetry, Complementary and Alternative Medicine, Spine, Chiropractic, Medicine, and 15 morePhysical Medicine and Rehabilitation, Humans, Movement, Kinematics, Pubmed, Dislocations, Palpation, Cervical Vertebrae, Posture, Clinical Sciences, Three Dimensional, Sensitivity and Specificity, Thoracic Vertebrae, Biomechanical Phenomena, and lumbar vertebrae
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Objective: To compare the current knowledge of 3-D spinal mechanics and abnormal equilibrium states with chiropractic motion theories, chiropractic vertebral letter listing theories, and chiropractic technique theories. Data collection: A... more
Objective: To compare the current knowledge of 3-D spinal mechanics and abnormal equilibrium states with chiropractic motion theories, chiropractic vertebral letter listing theories, and chiropractic technique theories. Data collection: A manual search of available reference texts and a computer search of literature from Index Medicus were collected with an emphasis on 3-D studies of human spinal movements, segmental instability, Euler buckling of the spine, and chiropractic theories concerning vertebral movements. Results: Previous spinal coupling results based upon two-dimensional radiographic studies are inadequate and inaccurate. Therefore, the validity of any chiropractic technique procedure, listing, motion analysis or adjusting style based on the two-dimensional radiograph and coupling studies must be questioned. We have identified four types of spinal subluxations (displacements) in the biomechanical literature: (a) posture main motion and associated segmental coupling, (b) Euler buckling viewed in the anteroposterior view, (c) snap through viewed in the lateral view and (d) segmental instability. Conclusions: Full three-dimensional investigations of spinal coupling patterns have shown that the vertebrae rotate and translate in all three axes and that previous theories of spinal coupling based upon two-dimensional studies are inaccurate and invalid. Previous chiropractic letter listings (e.g., PRI, PLS, etc.) of spinal displacements are inadequate and invalid. Only one of the four types of biomechanical displacements, segmental instability, is consistent with the traditional chiropractic theory of segmental spinal displacements; in general, this does not respond well to care. In general, vertebrae displacement must be viewed in the context of equilibrium configurations and one vertebra can not be displaced as an individual misalignment. Validity questions arise for any technique methods that use letter listings of displacement taken from motion palpation or two-dimensional radiographic analysis.
Research Interests: Photogrammetry, Complementary and Alternative Medicine, Spine, Chiropractic, Medicine, and 15 morePhysical Medicine and Rehabilitation, Humans, Movement, Kinematics, Pubmed, Dislocations, Palpation, Cervical Vertebrae, Posture, Clinical Sciences, Three Dimensional, Sensitivity and Specificity, Thoracic Vertebrae, Biomechanical Phenomena, and lumbar vertebrae
Objective: To investigate the reliability of a specific method of radiographic analysis of the geometric configuration of the lumbopelvic spine in the sagittal plane, and to investigate the concurrent validity of a computer-aided... more
Objective: To investigate the reliability of a specific method of radiographic analysis of the geometric configuration of the lumbopelvic spine in the sagittal plane, and to investigate the concurrent validity of a computer-aided digitization procedure designed to replace the more tedious and time-consuming manual measurement process. Design: A blind, repeated-measures design was used. The results of radiographic measures derived through the traditional manual marking method were compared with measures derived by computer-aided digitization of lateral lumbopelvic radiographs. Setting: Private chiropractic clinic. Main outcome measures: Pearson's product-moment correlation coefficients, paired sample t tests and intraclass correlation co-efficients (ICC) were used to examine intraexaminer reliability, and repeated measures of analysis of variance were used to examine interexaminer reliability for relative rotation angles for T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, L5-S1, overall lordosis measurement [absolute rotation angle (ARA)] from L1-L5 and Cobb angle of overall lordosis measured from the inferior surface of T12 to the superior surface of S1, Ferguson's sacral base angle to horizontal, angle of pelvic tilt (arcuate angle) to horizontal and anteroposterior thoracic translation (Sz) in millimeters. Results: ICC estimates for intraexaminer reliability were in the range of 0.96-0.98 for the L1-L5 ARA, a range of 0.87-0.99 for the arcuate angle measurement, 0.83-0.94 for the Ferguson's angle measurement, 0.88-0.95 for the Cobb angle measurement from the inferior surface of T12 compared with the superior surface of S1 and 0.98-1.00 for the translation measurement of the lower thoracic spine to S1 (Sz). The intersegmental measurement's (T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, L5-S1) correlations ranged from a low of 0.55 to a high of 0.97. Examination of these findings suggests that the reliability for the three doctors is acceptable with only the T12-L1 intersegmental measure falling below 0.70 for the least experienced examiner. Average ICC of interexaminer reliability for manual and computer-aided digitizing examiners were the following: 0.96 for the L1-L5 ARA; 0.84 for the arcuate angle measurement; 0.82 for the Ferguson's angle measurement; 0.88 for the Cobb angle measurement; 1.00 for the Sz translation measurement; and values of 0.65, 0.73, 0.74, 0.75, 0.89 and 0.81 for relative rotation angle measurements T12-L1, L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1, respectively. Conclusion: The data tend to support the reliability of this method of radiographic analysis of the geometric configuration of the lumbopelvic spine as viewed on lateral lumbopelvic radiographs. The additional data presented here tend to support the concurrent validity of the computer-aided digitization method of analysis inasmuch as the measures determined by the digitizing examiners are essentially identical to those determined by the manual method plus or minus the average standard error of measure of each value.
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Background: Current medical, biomechanical, and chiropractic literature indicates that X-ray line drawing analysis for spinal displacement is reliable, with high Interclass Correlation Coefficients (ICCs) found in most studies. Normal... more
Background: Current medical, biomechanical, and chiropractic literature indicates that X-ray line drawing analysis for spinal displacement is reliable, with high Interclass Correlation Coefficients (ICCs) found in most studies. Normal sagittal spinal curvatures are being accepted as important clinical outcomes of care; however, just the opposite is taught in many chiropractic college radiology courses. Objective: To review the current literature on X-ray line drawing reliability and abnormal static lateral positions. Data sources: Searches were performed on Medline, Chiro-LARS, MANTIS, and CINAHL on X-ray reliability, normal spinal position, and sagittal spinal curvatures as clinical outcomes. Results: X-ray line drawing analysis for spinal displacement was found to have high reliability with a majority of ICCs in the .8-.9 range. The reliability for determining X-ray pathology was found to be only fair to good by both medical doctors and chiropractors and by both chiropractic and medical radiologists, with a majority of ICCs in the range .40-.75. Muscle spasms, facet hyperplasia, short pedicles and patient positioning errors have not been shown to alter sagittal plane alignment. The sagittal spinal curves are desirable clinical outcomes of care in surgery, physical therapy, rehabilitation and chiropractic. These results contradict common claims found in the indexed literature. Conclusion: X-ray line drawing is reliable. Normal values for the sagittal spinal curvatures exist in the literature. The normal sagittal spinal curvatures are important clinical outcomes of care. Patient positioning and postural radiographs are highly reproducible. When these standardized procedures are used, the pre-to-post alignment changes are a result of treatment procedures applied. Chiropractic radiology education and publications should reflect the recent literature, provide more support for X-ray line drawing analyses and applications of line drawing analyses for measuring spinal displacement on plain radiographs.
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Objective: Traditional forms of chiropractic treatment methods have attempted to restore alignment of vertebrae to proposed "normal" positions. Although this approach has existed throughout chiropractic's 100-yr history, little has been... more
Objective: Traditional forms of chiropractic treatment methods have attempted to restore alignment of vertebrae to proposed "normal" positions. Although this approach has existed throughout chiropractic's 100-yr history, little has been written in the scientific literature in support of this approach. The objective of this review is to study further the rationale behind this approach and evaluate some of the mechanical, anatomical and physiological evidence upon which this chiropractic approach is based. Study selection: Articles and studies were selected that discuss analysis of stress and strains in spinal tissues from gravitational loading and experimental deformation in human and animal models. Studies that included radiographic measurements and classifications of spinal configuration in the sagittal plane were reviewed for their relevance to the chiropractic concept of a typical, usual or normal spinal configuration against which to compare patients. Conclusion: The usual, typical or normal configuration of the cervical spine in the sagittal dimension is a lordosis with a range of 16.5-66 degrees when measured as tangent lines along the cervical curve of the posterior vertebral body margins of C2 and C7. An analysis of stresses and strains supports this claim, as do studies from the scientific literature that attempt to measure and classify average cervical configuration from large population bases. The use of normative data as a gauge against which to measure patients' structural health and as an outcome of the degree of success or failure of chiropractic interventions seem to be logical consequences of these findings.
Research Interests: Complementary and Alternative Medicine, Spine, Chiropractic, Treatment Outcome, Medicine, and 13 moreHumans, Computer Simulation, Pubmed, Cervical Vertebrae, Clinical Sciences, Theoretical Models, Mechanical Stress, Reference Values, Kyphosis, Spinal manipulation, Biomechanical Phenomena, lumbar vertebrae, and Lordosis
Objective: To examine the biomedical literature pertaining to the anatomy and biomechanics of the sacroiliac (SI) joint to update current concepts and treatment of SI joint dysfunctions. Data collection: The biomedical literature was... more
Objective: To examine the biomedical literature pertaining to the anatomy and biomechanics of the sacroiliac (SI) joint to update current concepts and treatment of SI joint dysfunctions. Data collection: The biomedical literature was reviewed for articles containing information on the anatomy, mechanics, dysfunction and treatment of the SI articulation. Emphasis was placed on information published in the past decade. Textbooks and prior reviews were used to compare past and present information. Results: The anatomy and mechanics of the SI joint and surrounding tissues are much more complex than taught in chiropractic colleges and technique systems. The motion of the joint is complex, involving simultaneous rotations of 3 degrees or less and translations of 2 mm or less in three dimensions. The axes of motion for the SI joint are not straightforward and are largely dependent upon the surface topography of the joints. Traditional chiropractic types of dysfunctions and displacements are oversimplified and specific SI joint adjustments have not been demonstrated to correct these displacements. The primary function of the integrated SI system is the transmission and dissipation of mechanical forces. History, physical examination and clinical diagnostic tests have failed to demonstrate predictive validity for true SI dysfunction. Conclusion: Treatment of the SI articulation is difficult and all known SI joint tests have questionable validity, with the exception of pain provocation tests. Clinical treatment should be aimed at improving the stability of the surrounding soft tissues and at reducing mechanical stresses and strains from poor posture or using orthotics to level the sacral base. Much more research is needed in the treatment of this area.
