Biomechanical Effects of Position-Loading During Cervical Rotatory Manipulation: A Finite Element Analysis
Abstract Background: Cervical rotatory manipulation(CRM) is one of the most common treatments for neck pain in China. This study utilized a finite element method (FEM) to model the biomechanical effects of positioning during CRM in a normal sitting position. Methods: Passive head kinematics data, including angular displacement in six directions, were recorded. These data were then imported and a finite element model constructed, then validated. Relative angular displacements, and stress on the intervertebral discs and articular surfaces were calculated in a standard symmetry model (SSM) and compared with a pathological model (PM).Results: The results indicate that the intervertebral disc pressure (IDP) at the C2-C3, C3-C4 and C4-C5 discs subjected to CRM with position-loading were lower than the pressures experienced without position-loading. Furthermore, IDP on the target C5-C6 segment during CRM with position-loading in the PM was lower than that without position-loading, the former being close to the IDP of the C5-C6 segment during CRM without position-loading in the SSM. The left articular surface contact pressure of the target C5-C6 segment subjected to CRM towards the right without position-loading in the PM was slightly lower than that of the right articular surface experiencing leftward manipulation and lower than that predicted by the SSM. However, contact pressure of the C5-T1 segment in leftward CRM with position-loading in the PM and C6-T1 in rightward CRM with position-loading in the PM were significantly higher than the standard threshold, especially for contact pressure on the articular surfaces of C5-C6 in leftward CRM with position-loading in the PM. Conclusions: CRM should be considered a promising strategy to mitigate neck pain in patients.