Manual Cervical Traction and Trunk Stabilization Cause Significant Changes in Upper and Lower Esophageal Sphincter: A Randomized Trial

Cervical manipulation accelerates recovery and further correction of cervical alignment in mechanical neck pain (MNP) patients with neck exercise: A randomized controlled trial

BACKGROUND

Mechanical neck pain (MNP) is often associated with changes in cervical sagittal alignment, causing pain and functional limitations.

OBJECTIVE

This study evaluated the additional effects of cervical manipulation in patients with MNP undergoing neck retraction exercise.

METHODS

Patients with MNP were randomly assigned to either the cervical manipulation plus neck retraction exercise group (CM + NRE) or the neck retraction exercise group (NRE). Both groups completed their respective regimens over an 8-week period. Primary outcomes include visual analogue scale (VAS) and cervical range of motion (CROM). Secondary outcomes include neck disability index (NDI), neck muscle strength, and cervical sagittal alignment (relative rotation angles [RRA]; absolute rotation angles [C2-7ARA]; cervical sagittal vertical axis [c2-7SVA]). The statistical analysis applied intention-to-treat (ITT) and per-protocol (PP) analyses.

RESULTS

In the ITT analysis, the CM + NRE group demonstrated more pronounced changes in VAS and CROM after the first treatment (VAS: d = 1.83, P = 0.001; CROM: d = 1.92, P = 0.001), at 4 weeks (VAS: d = 0.98, P = 0.001; CROM: d = 1.05, P = 0.001), 8 weeks (VAS: d = 1.05, P = 0.001; CROM: d = 0.93, P = 0.001), and at a 4-week follow-up (VAS: d = 1.16, P = 0.001; CROM: d = 0.91, P = 0.001). In the assessments of NDI, RRA, and C2-7ARA, the CM + NRE group showed significantly greater changes compared to the NRE group (p < 0.05). These results were consistent with the PP analysis.

CONCLUSION

Cervical manipulation enhances the effectiveness of neck retraction exercise, which promotes rapid recovery from neck pain and stiffness and further facilitates the correction of cervical sagittal alignment in patients with MNP.

Inter-rater reliability of the dynamic neuromuscular stabilization diaphragm tests among individuals with non-specific low back pain and neck pain

BACKGROUND

The Dynamic Neuromuscular Stabilization (DNS) diaphragm test and intra-abdominal pressure regulation test (IAPRT) are qualitative clinical tests that assess postural stability provided by the diaphragm.

OBJECTIVE

Evaluate the inter-rater reliability of the diaphragm test and IAPRT between an experienced and novice DNS clinician among individuals with non-specific low back pain (LBP) and neck pain.

METHODS

Forty-five participants with non-specific LBP and/or neck pain were assessed by an experienced and novice DNS physiotherapist in the diaphragm test and IAPRT, and scored on a visual analog scale (VAS) according to five different criteria.

RESULTS

Moderate reliability was noted when assessing LBP and neck pain patients in the diaphragm test and IAPRT (p < 0.001). Moderate reliability also existed when assessing only LBP (p < 0.001) or neck pain (p = 0.002, p = 0.009) independently. Patients with lower pain (NPRS score of 5 or < ) demonstrated lower intra-class correlation coefficients, yet still moderate reliability in the diaphragm test (p = 0.004) and IAPRT (p = 0.001). Patients with higher pain (NPRS score of 6 or > ) demonstrated greater intra-class correlation coefficients, with the diaphragm test resulting in good reliability (p < 0.001).

CONCLUSIONS

The diaphragm test and IAPRT demonstrate moderate reliability between an experienced and novice DNS clinician when evaluating LBP and neck pain patients, with a greater degree of reliability noted in patients suffering from higher reported pain.

Comprehensive therapy of upper functional dyspepsia: the potential of herbal medicines

Comprehensive therapy of upper functional dyspepsia: the potential of herbal medicines Functional gastrointestinal disorders are among the most common diseases. The treatment of these conditions must be comprehensive. The foundation of therapy includes lifestyle modifications, appropriate dietary adjustments, physiotherapy, and pharmacotherapy. Herbal medicines can also play a significant role in self-treatment.

Remission of cervicogenic dysphagia associated with biomechanical dysfunction following chiropractic therapy

Cervicogenic dysphagia is a complex condition that can arise from biomechanical dysfunction in the cervical spine. Conventional treatment outcomes are not always guaranteed. Chiropractic treatment is considered an alternative treatment for dysphagia, yet there is a lack of evidence supporting its effectiveness. We present the case of a 48-year-old male who had difficulty swallowing for eight months. He had a feeling of food stuck in his throat when eating hard food but without any pain when swallowing, and eventually, he could not swallow any dry food. He was diagnosed with dysphagia associated with an anxiety disorder and was treated with medication, but there was no improvement in his condition. A full-spine radiograph revealed biomechanical dysfunction, including reduced cervical lordosis and levoscoliosis of the upper thoracic spine. After nine months of conventional physiotherapy, the patient completely recovered from his symptoms, with significantly improved biomechanical parameters. This study highlights the potential mechanism of cervicogenic dysphagia and the effect of chiropractic treatment in managing it. Applying chiropractic treatment, including spinal manipulative therapy, instrument-assisted soft tissue manipulation, and mechanical traction, might bring a positive outcome for dysphagia patients with careful consideration.

Abdominal wall tension increases using Dynamic Neuromuscular Stabilization principles in different postural positions

BACKGROUND

Intra-abdominal pressure (IAP) is an important mechanism stabilizing the spine and trunk. IAP regulation depends on the coordination of abdominal muscles, diaphragm and pelvic floor muscles.

OBJECTIVE

To determine the differences in abdominal wall tension (AWT) of various postural positions, first without any correction, then after verbal and manual instructions according to Dynamic Neuromuscular Stabilization (DNS) principles.

METHODS

In a cross-sectional observational study, thirty healthy individuals (mean age = 22.73 ± 1.91 years) were fitted with two Ohmbelt sensors contralaterally above the inguinal ligament and in the upper lumbar triangle. AWT was measured during five postural positions: sitting, supine with legs raised, squat, bear and hang position. First, spontaneous AWT was measured, then again after manual and verbal instructions following DNS principles.

RESULTS

AWT increased significantly with DNS instructions compared to spontaneous activation. Both sensors recorded significant increases (p < .01; Cohen's d = -1.13 to -2.06) in all observed postural situations. The increase in activity occurred simultaneously on both sensors, with no significant differences noted in pressure increases between the sensors. The greatest activation for both sensors occurred in the bear position. Significant increases in activity were identified for both sensors in the supine leg raise position and in the bear position compared to spontaneous activation in sitting (p < .001). There were no statistically significant differences (for both sensors) between women and men in any position.

CONCLUSION

The amount of AWT significantly increases after verbal and manual instructions according to DNS. The greatest abdominal wall activation was achieved in the bear position.