SMT-1 Manual, pgs 34-44 Flashcards
When did TrA and Internal Oblique muscle thickness increase after SMT? (koppenhaver etal 2011)
3-4 days immediately after 2 session of SMT, but did not remain
How much force is needed in the T-Spine?
238N
At what acceleration does a Cavitation generally occur?
72*sec
According to Bolten et al 2007, performing C3/4 HVLAT with side bending caused cavitation on which side?
Ipsilateral
Duration of a HVLAT
0.135sec (Triano 1992)
80-200 ms (Herzog 1993)
158 ms (Ngan 2005)
102 ms Kawchuck
How fast is the thrusting phase accomplished?
80-200ms (Herzog et. al (93))
How much force is needed for a cervical HVLAT?
118N (Kawchuk et al 1992)
What is the average of peak pressure movement during thoracic manipulation?
9.8 mm (1cm) (Herzog & Symons 2001)
According Gal et al 1997 how much axial rotation occurred at T10-T12?
0.4-1.2*
Acceleration needed for HVLAT
2183*/sec2
Did TrA muscle thickness change after SMT correlate with ODI scores? (koppenhaver etal 2011)
no thickness changes occurred regardless of improved disability or not
Reversal of long term potentiation will cause what?
Spinal LTD- Long term depression
What is the average rate force application for a HVLAT?
1368N/S (Herzog & Symons 2001)
Where might similar changes in LTP occur?
Central/Supraspinal synaptic targets resulting in central suppression
Fernandez-de-las Penas et al 2007 found what changes in PPT over lateral epicondyle after a C5-C6 HVLAT compared to sham or control?
35.5% increase in PPT in ipsilateral elbow; 24.8% increase for contralateral elbow
According to Boal and Gillette 2004 how does SMT reduce pain?
SMT restores “normal” position allowing release of analgesic agents
What is considered the most athoratitve systematic review on treatment of neck pain?
Gross et al 2004
what is the first pain response?
A-delta
what may SMT reverse?
LTP- long term potentiation
When does Long Term Depression occur?
within seconds after SMT and can last for hours
What is neuronal plasticity?
behavioral changes in dorsal horn neurons influenced by previous events contributing to persistent pain states (i.e. LTP or central sensitization) or the reverse (LTD)
Neuronal plasticity provides mechanisms that contribute to amplification synaptic transmission in nociceptive circuits lending to central neuronal elements overreacting to normal input w persistent hyper-excitability
The mean joint compliance of a joint manipulated increased by ____ from pre to post HVLAT compared with ____ for non manipulated side.
- 5mm (HVLAT)
0. 1mm (non-HVLAT)
According to Mansilla-Ferragut et al 2009 mouth opening increased by how many mm after 1 OA bilateral HVLAT?
3.5mm
what is the level of evidence that treatment manipulation is an adjunct to PT care for pain reduction in acute/subacute WAD?
very low quality of evidence
How much mean (global) peak force is needed for a thoracic HVLAT?
238N (Herzog & Symons 2001)
How far off the barrier should you come for pre-thrust?
4.8 degrees
Ngan et al 2005
What does the systematic review by Assendelft et al 2004 state?
SMT or mob superior to sham and to detrimental or ineffective treatments, but not better than other LBP interventions
How Many degrees thru the barrier do you need? (mean thrust displacement barrier)
11.4 (Ngan et al. 2005)
13* (Triano & Schultz (1994))
How does SMT alter afferent input to the CNS?
it alters the reflex mechanism and ascending/descending pain modulating elements
what is responsible temporal summation/2nd pain response?
C-fibers
What did George et al 2006 investigate?
immediate hypoanalgesic effect of lumbar SMT on thermal pain sensitivity in Asymptomatic subjects (obtained before and 5 minutes after lumbar SMT)
According Gal et al 1997 how many mm of movement occurred at T10-T12?
6-12 mm anteriorly & 3-6 left lateral translation
How fast is the “high-velocity” in thrust?
Mean time onset to peak force 0.135 seconds. 1/10th of a second
According to Hertoz et al 1993, the thrusting phase is accomplished in how many ms?
80-200ms
what is the level of evidence that certain mobs may be superior to others?
very low quality of evidence that a/p mobs are more effective than transverse oscillatory or rotational for acute/subacute neck pain
According Gal et al 1997 how much saggital movement occurred at T10-T12?
0.5-1.8*
According to Mansilla-Ferragut et al 2009 1 OA bilateral HVLAT increased PPT over the sphenoid. What are 3 explanations for this?
1) New position of OA
2) Increased cervical ROM and Increased Mouth opening
3) decreased reflex inhibition of the masseter muscle - hypothesized nocioceptive inputs from upper cervical causes reflex contraction of mastication muscles decreasing TMJ ROM
What is the general reaction time of a pt?
200ms
At what segment did thickness occur? (koppenhaver etal 2011)
L5/S1
According to Ross et al. in 2004, what was the average error from (in centimeters) the targeted thoracic joint?
3.5cm
According to Bolten et al 2007, performing C3/4 HVLAT with roation caused cavitation on which side?
Contralateral to Applicator
According to Ross et al. in 2004, what was the average error of cavitation from the targeted lumbar joint(in centimeters)?
5.29cm
what it is the evidence that there is a difference in pain reduction for chronic neck pain when comparing unilateral to central PA mobilizations?
low quality of evidence
what is the counter irritant effect?
co-activation of A-beta and A-delta and C-fiber mechanosensitive afferents; similar to TENS, acupuncture and vigorous deep massage
According to Bale and Newell 2005 chronic neck pain required how many SMT treatments?
average 10 weeks 31%= 4x’s, 62%= 5-10x’s, 7% >/= 10x’s
What is the level of evidence that cervical SMT produces changes in pain and disability compared to cervical mobilization for subacute or chronic neck pain at short term follow up?
moderate to low quality of evidence
What is the mean duration of force for cervical HVLAT?
102ms (Kawchuk et al 1992)
According to Herzog et al 1993, what is the thrust duration for the thoracic and SI joints in ms?
120-200ms
What is the quality of evidence that a single treatment manipulation is effective compared to placebo for chronic neck pain?
low quality of evidence
According to Bale and Newell 2005 acute neck pain required how many SMT treatments?
4 SMT’s over 3 weeks
How much preload mean force for thoracic HVLAT?
24N (Herzog & Symons 2001)
Did Beffa & Matthews 2004 demonstrate a significant difference in target joint caviation for L5/S1 or SIJ?
No; L5/S1 Cavitated L3/4 & SIJ cavitated L5/S1
Reggars 1996 found the average number of cavitations during C3/4 HVLAT is ____.
2.5
What is the average peak thrust Velocity needed for HVLAT
127*sec (Ngan et al 2005)
What population has long term depression been proven in?
LTD demonstrated in rats dorsal horn neurons after A-delta stimulation decreased Long term potentiation (central) previously established by C-fibers
According to Mansilla-Ferragut et al 2009 1 OA bilateral HVLAT increased pressure pain threshold over which bone?
Sphenoid
According to Gross et al 2010 Cochrane review could ideal dosage of cervical SMT or cervical mobilization be determined?
no
According to Koppenhaver et al 2011 did transverse abdominis and lumbar multifidus thickness change after Chicago technique?
Yes - contracted thickness decreased immediately after SMT but not significantly different after 3-4 days or 1 week.
What does the Gross et al 2004 systematic review state?
SMT or mob if effective only when combined w/ exercise and as a sole treatment is not effective
What is the evidence that cervical SMT alone provides immediate and short term relief following 1-4 sessions, but not long term?
low quality of evidence
What is the mean peak force of C-Spine HVT?
118N (Kawchuk et al 1992)
According to Ernst and Carter 2006 what systematic review is the most authoritative for treatment of LBP?
Assendelft et al 2004
According to Martinez-Sequra et al 2006 how effective was a single C3-C5 HVLAT on neck pain compared to a pre-manip hold for 30 seconds?
VAS score change 3.5/10 for HVLAT 0.4/10 for sham. Single C3-C5 HVLAT more effective to decrease neck pain at rest and increase AROM