CJA Vol.32 Issue 3Editorial: New Game, New Rules - p77 Response of Cervicobrachial Neuralgia to
Chiropractic Care - p78 EMG Response of the Human Frame to Wearing a
Backpack—A Review - p83 Backpack Design: The Use of Ratings of Perceived
Exertion ( Borg Scale) - A Review - p91 Did the SMT Practitioner Cause the Arterial Injury?
- p99 In Memoriam - Elmer L. Crowder - p111 ABSTRACTS Response of Cervicobrachial Neuralgia to Chiropractic Care JASON D. LEMON Objective: To present a case series of three patients presenting with cervicobrachial neuralgia who were successfully treated with chiropractic management. Clinical Features: Three patients suffering from unilateral shoulder or arm pain and C7 nerve root compression are described. Intervention and Outcome: All patients received postural advice, cervical ROM stretches, deep massage to the cervicothoracic spine, and chiropractic manipulation. All patients receiving chiropractic care achieved a satisfactory resolution of their symptoms. Conclusion: Chiropractic management, including manipulation, appears to be a highly effective means of treating cervicobrachial neuralgia. INDEX TERMS: CERVICOBRACHIAL NEURALGIA; CHIROPRACTIC; MANIPULATION; INTERVERTEBRAL DISC HERNIATION; CERVICAL RADICULOPATHY. EMG Response of the Human Frame to Wearing a Backpack-A Review ANDREW L. VITIELLO and HENRY POLLARD Objective: To review current scientific knowledge pertaining to backpacks and various other modalities employed to carry loads. A second objective of this paper is to comment on current methods of assessing the effects of load and carriage on the human body. The reviewers have contrasted the potential benefits of surface electromyography (s-EMG) over metabolic assessment measures in preparing this review. Data Sources: The current scientific literature was examined using the MEDLINE® database and was accessed using the PUBMED® online search engine. The MANTIS® database was also searched for additional material. Study Selection: Sixty-three journal articles were chosen from a selection of 104. Of these, 38 that pertained to the aims of this discussion were included. Data Extraction: The journals were selected based on relevance to the topic discussed, i.e. results pertaining to EMG, metabolic measurement approaches, assessment of different load carriage methods, load placements on the spine as well as effects loads have on the spine, gait or general biomechanics of the human frame. Data Synthesis: From the literature, we find that EMG is a valid but poorly utilised tool in assessing the effects of load on the human frame. There is yet little evidence to suggest a clear rationale behind the determination of an ideal backpack weight that can be used as a guideline for advising wearers. Conclusion: Ideal load placement on the human frame requires further and more detailed study. The relationship between the level of perceived exertion and the EMG trace still requires further large-study investigation. The literature supports the notion that Mean Power Frequency (MPF) analysis can be used as a reliable and repeatable method of determining fatigue in smaller muscle groups. Its use should be favoured against more global and less specific metabolic measures. Observations in both children and adolescents have found that painful syndromes may occur because of overloaded backpacks. Longitudinal observations are needed to confirm a causative link between these loaded states and painful syndromes. INDEX TERMS: (MeSH): LOAD; ELECTROMYOGRAPHY; WEIGHT BEARING; (OTHER): BACKPACKS; SCHOOL CHILDREN. Backpack Design: The Use of Ratings of Perceived Exertion (Borg Scale)-A Review ANDREW L. VITIELLO and HENRY POLLARD Objective: To consider the design features of backpacks in light of current scientific knowledge. Particular focus is drawn to the methods used to assess the benefits of assisted load carrying. The second objective is to discuss the increasingly dated knowledge regarding clinical use of surface EMG (s-EMG) and Ratings of Perceived Exertion (RPE) as valid tools in the assessment. Data Sources: The current scientific literature was examined using the MEDLINE® database and was accessed using the PUBMED® online search engine. The MANTIS® database was also searched for additional material. Study Selection: Forty-six journal articles were chosen from a selection of 104 that had satisfied the online search criteria and pertained to the aims of this discussion. Data Extraction: Journal articles were included based on relevance to the topics discussed. Selected articles had particular results pertaining to either electromyography (EMG), RPE assessment of different load carriage methods, load placements on the spine and the effects loads have on the spine and gait. Data Synthesis: From the literature, we find that s-EMG is a valid tool for use in clinical assessment of muscular effects of load on the human frame. We have found that more extensive trials need to be performed, using larger sample sizes, matched groups and extensive sampling points in order that s-EMG can be readily utilised by the wider scientific community for such analyses. Conclusion: It is apparent that placement of a load as close as possible to the centre of mass of the body is important, especially when considering these concepts to relate the weight carried to fatigue, as well as to specific bag design features. There is evidence to suggest that in the adult population fatigue can be reduced if loads are kept as close as possible to 30% of the wearer’s lean body mass, while the 10% maximum load for children is a figure that requires further exploration in order to justify completely. The literature supports use of a combination of both s-EMG and Borg scales (RPEs) as acceptable, valid, repeatable measures to test the body’s responses to loads using different backpack designs. INDEX TERMS: (MeSH): LOAD; ELECTROMYOGRAPHY; WEIGHT BEARING; (OTHER): BACKPACKS; SCHOOL CHILDREN. Did the SMT Practitioner Cause the Arterial Injury? ALLAN G.J. TERRETT The close temporal relationship between cervical spinal manipulation therapy (SMT) and the development of brain, brainstem and/or ischaemic incidents suggests a cause-and-effect relationship. This conclusion is strengthened by anatomical, biomechanical and pathologically plausible mechanisms to account for the onset of central nervous system symptoms and signs, and may incorrectly lead investigators (medical, insurance, legal and press) to the conclusion of an obvious cause-and-effect relationship. Other mechanisms for identical outcomes are investigated in this paper. INDEX TERMS: (MeSH): VERTEBRAL ARTERY; CHIROPRACTIC; OSTEOPATHIC MEDICINE; PHYSICAL THERAPY; MALPRACTICE; RISK MANAGEMENT; CERVICAL VERTEBRAE; CEREBROVASCULAR DISORDERS; WALLENBERG’S SYNDROME; QUADRIPLEGIA; ADVERSE EFFECTS;; IATROGENIC DISEASE; (OTHER): ARTERIAL DISSECTION. |
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