Efficacy and safety of Shi-style cervical manipulation therapy for treating acute and subacute neck pain: study protocol for a randomized controlled trial

Background Neck pain is a common clinical disease, which seriously affects people’s mental health and quality of life and results in loss of social productivity. Improving neck pain’s curative effect and reducing its recurrence rate are major medical problems. Shi’s manipulation therapy has unique advantages and technical features that aid in the diagnosis and treatment of neck pain. Compared with first-line non-steroidal anti-inflammatory drug (NSAID) treatment of neck pain, Shi’s cervical manipulation lacks the relevant research basis of therapeutic advantage, safety, and satisfaction for treating acute and subacute neck pain. Herein, we aim to confirm our hypothesis in a clinical trial that the safety and efficacy of Shi’s cervical manipulation will be more effective, safer, and more satisfactory than NSAIDs to treat acute and subacute neck pain. Methods In this multicenter, positive-controlled, randomized clinical trial, traditional analgesic drug (NSAID) is used to evaluate and show that Shi’s manipulation is more effective, safe, and satisfactory for treating acute and subacute neck pain. Overall, 240 subjects are randomly divided into the trial and control groups, with both groups treated by the corresponding main intervention method for up to 12 weeks. Clinical data will be collected before the intervention and immediately after the first treatment; at 3 days and 1, 2, 4, 8, and 12 weeks after the intervention; and at 26 and 52 weeks after treatment follow-up of clinical observation index data collection. The clinical observation indices are as follows: (1) cervical pain is the primary observation index, measured by Numerical Rating Scale. The secondary indices include the following: (2) cervical dysfunction index, measured by patient self-evaluation using cervical Neck Disability Index; (3) cervical activity measurement, measured by the cervical vertebra mobility measurement program of Android mobile phone system; (4) overall improvement, measured by patient self-evaluation with SF-36; and (5) satisfactory treatment, determined by patient self-evaluation. Discussion We will discuss whether Shi’s cervical manipulation has greater advantages in efficacy, safety, and satisfaction of acute and subacute neck pain than traditional NSAIDs, to provide a scientific basis for the dissemination and application of Shi’s cervical manipulation. Trial registration China Registered Clinical Trial Registration Center ChiCTR1900021371. Registered on 17 February 2019

Comparison of Minor Vehicle Impact Occupant Spinal Dynamics to Reported Spinal Manipulation Therapy Loading

Motor vehicle impacts result in energy being transferred between the involved vehicles and subsequently to occupants within those vehicles. Similarly, when outside of a vehicle, humans constantly encounter energy transfers within their surrounding environment, inducing internal reactions within their bodies. A common method used by biomechanical engineers is to compare the exposure in a particular event to the general exposures during various activities of daily living (ADL). Such comparisons can be in terms of general inertial loading, such as accelerations, or in terms of specific joint loading (i.e., forces and/or moments). Regardless, to be comparable from the biomechanics standpoint, there needs to be sufficient correlation between the duration, magnitude and/or direction of acceleration or load application. An area of forensic science where such comparisons are common is when a biomechanical engineer is assessing an occupant’s exposure to a minor vehicle accident. In many of these events, the accelerations and loading present are found to be well below any published and accepted injury parameters and to be comparable to published exposures to various ADLs. In this study, spinal loading reported in the published literature during spinal manipulation therapy (SMT) is compared to published spinal exposures in minor vehicle accidents. Extensive research and associated publications regarding both accident reconstruction and biomechanical analyses have studied minor motor vehicle accidents. This current work does not attempt to provide a review of all the volunteer or surrogate studies of occupant exposures available. Instead, this work is the initial phase of a larger study to build on the body of literature that provides quantitative comparisons of human exposures to relatively minor real-world accidents and a wide variety of ADLs, including exposures during the application of common clinical therapies such as SMT. There is a relative lack of studies that quantify the loads applied to patients or develop within patients during various SMT inputs. However, the studies found that do provide quantification suggest that the spinal loading duration, magnitude and direction are similar to that shown to exist in many minor vehicle accidents. For example, Forand [4] reported that SMT inputs applied forces up to 1,000 Newtons (N) to a particular target site (i.e., disc) within a time duration of about 20 to 170 milliseconds (ms). By contrast, spinal loading durations in minor impacts have been shown in the biomechanics literature [9, 11 and 12] and publicly available testing [18] to have similar durations (50 to 250 ms) with distributed neck forces typically less than 500 N. This study has found that like many other ADLs, the spinal loading present during SMT may be comparable to that present in many minor vehicle impacts due to the similar duration, magnitude and direction of the joint loads.

New concept for uvula manipulation to treat puberphonia

Speech organs or articulators produce the sounds of language. The organs used for speech include the lips, teeth, alveolar bridge, hard palate, velum (soft palate), uvula, glottis, nasal cavity, pharynx and various parts of tongue. The vocal fold, in the larynx vibrates creating fluctuation in air pressure known as sound waves. The resonators of the mouth create formant regions and so different qualities sonorant (voiced) sound. We have a large series of vocal track vibrating endoscopic movie bank. We have created by treating 600 cases of puberphonia. We are able to record the change in the shape of the vocal tract and vibrating power of the airflow in the vocal tract. We are able to deduct and distinguish the different shape of the uvula and how airflow directed to the mouth by uvula. We are doing only uvula manipulation in treating puberphonia which gives immediate and persistent result. We are trying to bring out the importance of uvula in speech productions. The study concludes that the pharyngeal/uvula resonance manipulation therapy may be considered as an essential mode of treatment for puberphonia. Yet we like to inform that uvula is the structure in our body so little understood, so often abused and maligned.

Cervical epidural hematoma after spinal manipulation therapy: a case report

Background Cervical spinal manipulation therapy is a common non-invasive treatment for neck pain and stiffness, and has been widely used in the population. However, most people do not pay attention to the potential risks of neck manipulation, such as ligament damage, fractures, and spinal cord injuries. Epidural hematoma is a disease in which blood accumulates in the epidural space of the vertebral body. This disease is usually caused by trauma or iatrogenic surgery, and may be associated with blood coagulopathies, neoplasms, or degenerative spinal disease. Reports of epidural hematoma caused by cervical spinal manipulation are rare. Case presentation We present the case of a patient with tetraplegia and spinal shock after neck manipulation. A physical examination of the patient on admission found tenderness in the neck and increased muscle tension in both upper limbs. The superficial sensation of the upper limb disappeared, but the deep sensation still remained. The lower extremity had 0/5 power on both sides. The sensation below the T2 level completely disappeared. A cervical magnetic resonance imaging scan showed an acute posterior epidural hematoma from the C3–T3 vertebrae. Ultimately, the patient underwent emergency hematoma removal and showed partial improvement in symptoms of paralysis during follow-up. Conclusions Although spinal manipulation is simple and neck pain is common and recurrent in the general population, the basic condition and disease history of patients should be determined before manipulation. For high-risk patients, caution should be applied for cervical spinal manipulation or it should be prohibited. For a suspected hematoma, MRI should be used at an early stage to diagnose and locate the hematoma.