Chiropractic & Manual Therapies

doi: 10.1186/s12998-014-0050-7

Abstract

Practitioners in several of the health care professions use anatomical landmarks to identify spinal levels, both in order
to enhance diagnostic accuracy and to specifically target the site of intervention. Authoritative sources usually state
the upright inferior scapular angle (IAS) aligns with the spinous process (SP) of T7, but some specify the T7-8 interspace
or the T8 SP. The primary goals of this study were to systematically review the relevant literature; and conduct a
meta-analysis of the pooled data from retrieved studies to increase their statistical power. Electronic searching
retrieved primary studies relating the IAS to a spinal level, as determined by an imaging reference standard, using
combinations of these search terms: scapula, location, landmark, spinous process, thoracic vertebrae, vertebral level,
palpation, and spine. Only primary studies were included; review articles and reliability studies related to scapular
position but lacking spinal correlations were excluded. Eight-hundred and eighty (880) articles of interest were
identified, 43 abstracts were read, 22 full text articles were inspected, and 5 survived the final cut. Each article (with one
exception) was rated for quality using the QUADAS instrument. Pooling data from 5 studies resulted in normal distribution
in which the upright IAS on average aligns closely with the T8 SP, range T4-T11. Since on average the IAS most
closely identifies the T8 SP in the upright position, it is very likely that health professionals, both manual therapists
and others, who have been diagnosing and treating patients based on the IAS=T7 SP rule (the conventional
wisdom), have not been as segmentally accurate as they may have supposed. They either addressed non-intended
levels, or made numeration errors in their charting. There is evidence that using the IAS is less preferred than using the
vertebra prominens, and may be less preferred than using the iliac crest for identifying spinal levels Manual therapists,
acupuncturists, anesthesiologists, nurses, and surgeons should reconsider their procedures for identifying spinal
sites in light of this modified information. Inaccurate landmark benchmark rules will add to patient variation and
examiner errors in producing spine care targeting errors, and confound research on the importance of specificity
in treating spinal levels.

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The Journal of the American Osteopathic Association

doi: 10.7556/jaoa.2015.018

American Journal of Obstetrics & Gynecology

http://dx.doi.org/10.1016/j.ajog.2014.07.043

Abstract

OBJECTIVE: The purpose of this study was to evaluate the efficacy of osteopathic manipulative treatment (OMT) to reduce low back pain and improve functioning during the third trimester in pregnancy and to improve selected outcomes of labor and delivery.

STUDY DESIGN: Pregnancy research on osteopathic manipulation optimizing treatment effects was a randomized, placebo-controlled trial of 400 women in their third trimester. Women were assigned randomly to usual care only (UCO), usual care plus OMT (OMT), or usual care plus placebo ultrasound treatment (PUT). The study included 7 treatments over 9 weeks. The OMT protocol included specific techniques that were administered by board-certified OMT specialists. Outcomes were assessed with the use of self-report measures for pain and back-related functioning and medical records for delivery outcomes.

RESULTS: There were 136 women in the OMT group: 131 women in the PUT group and 133 women in the UCO group. Characteristics at baseline were similar across groups. Findings indicate significant treatment effects for pain and back-related functioning (P < .001 for both groups), with outcomes for the OMT group similar to that of the PUT group; however, both groups were significantly improved compared with the UCO group. For secondary outcome of meconium-stained amniotic fluid, there were no differences among the groups.

CONCLUSION: OMT was effective for mitigating pain and functional deterioration compared with UCO; however, OMT did not differ significantly from PUT. This may be attributed to PUT being a more active treatment than intended. There was no higher likelihood of conversion to high-risk status based on treatment group. Therefore, OMT is a safe, effective adjunctive modality to improve pain and functioning during the third trimester.

Key words: low back pain, osteopathic manipulation, pregnancy

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Manual Therapy

http://dx.doi.org/10.1016/j.math.2014.08.013

Abstract
Patellofemoral pain (PFP) is a common lower extremity condition observed in sports clinics. Recently, it
has been suggested that trunk motion could affect hip and knee biomechanics in the frontal plane. Thus,
the purpose of the study was compare trunk kinematics, strength and muscle activation between people
with PFP and healthy participants. In addition, the associations among trunk biomechanics, hip and knee
kinematics were analysed. Thirty people with PFP and thirty pain-free individuals participated. The peak
ipsilateral trunk lean, hip adduction, and knee abduction were evaluated with an electromagnetic
tracking system, and the surface electromyographic signals of the iliocostalis and external oblique muscle
were recorded during single-leg squats. Trunk extension and trunk flexion with rotation isometric
strength and side bridge tests were quantified using a handheld dynamometer. Compared with the
control group, the PFP group demonstrated increased ipsilateral trunk lean, hip adduction and knee
abduction (p = 0.02-0.04) during single-leg squat accompanied with decreased trunk isometric strength
(p = < 0.001e0.009). There was no between-group difference in trunk muscle activation. Only in the
control group, ipsilateral trunk lean was significantly correlated with hip adduction (r =0.66) and knee
abduction (r = 0.49); also, the side bridge test correlated with knee abduction (r = 0.51). Differences in
trunk, hip and knee biomechanics were found in people with PFP. No relationship among trunk, hip and
knee biomechanics was found in the PFP group, suggesting that people with PFP show different
movement patterns compared to the control group.

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