mercredi 25 mars 2020

Est-ce que la direction du thrust est importante? 🤔

Tous les ostéopathes et les partisans de Fryette diront que OUI la direction est importante. Pourtant nous pouvons émettre des réserves...
Karas et al (2016) ont cherchĂ© Ă  savoir si la direction d'un thrust sur les dorsales avaient un impact sur des patients cervicalgiques. 
69 patients cervicalgiques ont été assignés au hasard entre 2 groupes:










1er groupe: La manipulation correspondait au mouvement restreint du rachis thoracique (si le patient avait une restriction en Flexion, le thrust Ă©tait vers la Flexion...)
2e groupe: La manipulation se faisait dans le sens opposé à la restriction (si le patient avait une restriction en Flexion, le thrust était vers l'Extension...)

Résultats: Les 2 groupes avaient une amélioration significative et similaire au niveau de la douleur, du Neck Disability Index et de l'amélioration globale.


Conclusion: Les manipulations HVLA du rachis thoracique améliorent les cervicalgies et ce peu importe la direction sur le segment hypomobile.


Références:
Karas, S., Olson Hunt, M. J., Temes, B., Thiel, M., Swoverland, T., & Windsor, B. (2016). The effect of direction specific thoracic spine manipulation on the cervical spine: a randomized controlled trial. Journal of Manual & Manipulative Therapy, 26(1), 3–10. doi:10.1080/10669817.2016.1260674 



👉Si vous voulez enfin apprendre:

 ✅Comment manipuler sans contrainte et dans le confort
 ✅Comment intĂ©grer les manipulations HVLA dans un plan de traitement (quand manipuler ou quand ne pas manipuler)
 ✅Comment avoir un examen clinique objectif , fiable et reproductible
 ✅Comment ĂŞtre plus prĂ©cis et plus efficace dans les manipulations HVLA
 ✅Comment dialoguer avec les professionnels mĂ©dicaux et para-mĂ©dicaux
 ✅Pourquoi les manipulations sont actuellement bĂ©nĂ©fiques pour les disques intervertĂ©braux
 ✅Pourquoi il ne faut plus se baser sur les modèles de Fryette ou de Mitchell
 ✅Pourquoi les tests ostĂ©opathiques classiques doivent ĂŞtre abandonnĂ©s
 ✅Pourquoi les manipulations HVLA diminuent la douleur et augmentent les amplitudes articulaires...




    mercredi 18 mars 2020

    Est-ce qu'un diagnostic palpatoire est fiable? đź¤”

    Est-ce qu'un diagnostic palpatoire est fiable? đź¤”



    En ostĂ©opathie on nous parle souvent de la fiabilitĂ© de notre toucher. On nous apprend Ă  avoir des "mains qui pensent, sentent et voient"... 



    Mais qu'en est-il de la rĂ©alitĂ©? Est-on vraiment si prĂ©cis et fiable que ça avec notre palpation lors de l'examen clinique? đź¤”.

    Le GROS problème dans l'apprentissage de l'examen clinique c'est que nous reproduisons des tests dont nous ne savons pas s'ils sont fiables et valides...
    Nous ne savons pas assez si il y a une bonne reproductibilité des tests inter ou intra examinateur...
    L'examen de l'appareil neuro-musculo-squelettique est la base de notre traitement manuel (notamment en techniques HVLA).


    Exemple concret:
    Sur cette photo, on voit un examinateur palper les repères osseux des ischions et "diagnostiquer" un iliaque upslip (3 points haut)... Un cliché radio est fait pour vérifier. L'opérateur est persuadé de "diagnostiquer" une dysfonction traumatique...

    Après "correction", l'opérateur reteste et constate une
    amĂ©lioration de la symĂ©trie de hauteur des ischions. 
    Nous voyons très clairement qu'en fait il n'y a pas eu de changement...




    L'illusion palpatoire existe...


    Cet extrait du livre "Manipulative Therapy in Rehabilitation of the Locomotor System" (Karl LEWIT) met en lumière notre faiblesse à être aussi performant dans l'examen clinique que ce que l'on aimerait croire...

    Beaucoup d'autres études sont venues confirmer ces résultats.

    Pour autant, nous avons aujourd'hui des moyens de simplifier (gain de temps) et de rendre l'examen clinique encore plus fiable (gain d'efficacité).


    👉Si vous voulez enfin apprendre:

     ✅Comment manipuler sans contrainte et dans le confort
     ✅Comment intĂ©grer les manipulations HVLA dans un plan de traitement (quand manipuler ou quand ne pas manipuler)
     ✅Comment avoir un examen clinique objectif , fiable et reproductible
     ✅Comment ĂŞtre plus prĂ©cis et plus efficace dans les manipulations HVLA
     ✅Comment dialoguer avec les professionnels mĂ©dicaux et para-mĂ©dicaux
     ✅Pourquoi les manipulations sont actuellement bĂ©nĂ©fiques pour les disques intervertĂ©braux
     ✅Pourquoi il ne faut plus se baser sur les modèles de Fryette ou de Mitchell
     ✅Pourquoi les tests ostĂ©opathiques classiques doivent ĂŞtre abandonnĂ©s
     ✅Pourquoi les manipulations HVLA diminuent la douleur et augmentent les amplitudes articulaires...

    SĂ©minaires HVLA 2.0 



    samedi 7 mars 2020

    Manipulations et Disques Intervertébraux 🤔

    Quels sont les changements discaux après une manipulation lombaire chez un lombalgique? 

    On entend beaucoup de choses sur les manipulations et les disques intervertébraux...
    Délétères? Bénéfiques? Beattie et al (2014) ont voulu analyser les changements discaux à l'IRM juste après une manipulation lombaire HVLA.
    19 sujets lombalgiques (âgés de 20 à 45 ans) ont été sélectionnés. On leur a fait faire une IRM T2 ainsi qu'une mesure de la diffusion aqueuse (hydratation) juste avant et juste après une manipulation lombaire HVLA.

    Résultats: 12 patients ont eu une amélioration instantanée de leurs douleurs. Mais fait surprenant, les améliorations étaient corrélées à l'amélioration instantanée de la diffusion aqueuse aux niveaux L1-L2, L2-L3 et L5-S1.



    Conclusion: Les manipulations HVLA améliorent rapidement les lombalgies et ce en corrélation avec l'amélioration de l'hydratation des disques intervertébraux L1-L2, L2-L3 et L5-S1.

    Références:
    Beattie, P. F., Butts, R., Donley, J. W., & Liuzzo, D. M. (2014). The Within-Session Change in Low Back Pain Intensity Following Spinal Manipulative Therapy Is Related to Differences in Diffusion of Water in the Intervertebral Discs of the Upper Lumbar Spine and L5-S1. Journal of Orthopaedic & Sports Physical Therapy, 44(1), 19–29. doi:10.2519/jospt.2014.4967


    👉Si vous voulez enfin apprendre:

     ✅Comment manipuler sans contrainte et dans le confort
     ✅Comment intĂ©grer les manipulations HVLA dans un plan de traitement (quand manipuler ou quand ne pas manipuler)
     ✅Comment avoir un examen clinique objectif , fiable et reproductible
     ✅Comment ĂŞtre plus prĂ©cis et plus efficace dans les manipulations HVLA
     ✅Comment dialoguer avec les professionnels mĂ©dicaux et para-mĂ©dicaux
     ✅Pourquoi les manipulations sont actuellement bĂ©nĂ©fiques pour les disques intervertĂ©braux
     ✅Pourquoi il ne faut plus se baser sur les modèles de Fryette ou de Mitchell
     ✅Pourquoi les tests ostĂ©opathiques classiques doivent ĂŞtre abandonnĂ©s
     ✅Pourquoi les manipulations HVLA diminuent la douleur et augmentent les amplitudes articulaires...

    SĂ©minaires HVLA 2.0 



    dimanche 3 novembre 2019

    MTO VLOG#1: BE CURIOUS

    HERE IS THE 1ST VIDEO BLOG ON MANUAL THERAPIES ONLINE.
    THE SUJECT IS: BE CURIOUS


    lundi 29 avril 2019

    Effects of an 8-week physical exercise program on spinal manipulation biomechanical parameters in a group of 1st-year chiropractic students.


    Abstract

    OBJECTIVE::

    To determine the effects of a physical exercise program on spinal manipulation (SM) performance in 1st-year chiropractic students.

    METHODS::

    One hundred and thirteen students from 2 chiropractic schools were assigned to 1 of 2 groups: exercise group (EG) for campus A students or control group (CG) (no training) for campus B students. All participated in 2 1-hour experimental training sessions that were added to the usual technique curriculum. At the beginning and at the end of each session, SM thrust duration and preload force release were recorded as dependent variables in 5 trials performed on a force-sensing table for a total of 10 recorded trials per session. The session consisted of several drills during which augmented feedback was provided to students to improve their skills. The EG performed physical exercises (push-ups, core stabilization, and speeder board exercises) 3 times per week for an 8-week period between the 2 training sessions.

    RESULTS::

    The mean thrust duration increased between the 2 sessions [+0.8 ms (±15.6)]. No difference between groups was found using a t test for independent samples ( p = .94). The mean preload force release decreased between the 2 sessions (-6.1 N [±17.1]). Differences between groups were found using a t test for independent samples ( p = .03); the results showed a reduction of preload force release in the participants in the EG group compared to those in the CG group (-8.1 N [±16.9] vs -0.3 N [±16.5]).

    CONCLUSION::

    A physical exercise program seems to be beneficial in the SM learning process; chiropractic students should therefore be encouraged to do home physical exercises to develop their physical capabilities and improve SM delivery.


    The immediate effect of osteopathic cervical spine mobilization on median nerve mechanosensitivity

    Authors: Gary Whelan, M.Ost (Osteopath), Ross Johnston, M.Sc. B.Sc. (Hons) Ost Med, DO (Senior Lecturer), Charles Millward, ND DO (Lecturer), Darren J. Edwards, B.Sc. M.Sc. Ph.D. (Lecturer)
    Published in: J Bodyw Mov Ther. 2018 Apr;22:252-260. doi: 10.1016/j.jbmt.2017.05.009. Epub 2017 May 18.

    Abstract

    BACKGROUND:
    Neurodynamics is a clinical medium for testing the mechanical sensitivity of peripheral nerves which innervate the tissues of both the upper and lower limb. Currently, there is paucity in the literature of neurodynamic testing in osteopathic research, and where there is research, these are often methodologically flawed, without the appropriate comparators, blinding and reliability testing.
    AIMS:
    This study aimed to assess the physiological effects (measured through Range of Motion; ROM), of a commonly utilized cervicalmobilization treatment during a neurodynamic test, with the appropriate methodology, i.e., compared against a control and sham. Specifically, this was to test whether cervical mobilization could reduce upper limb neural mechanical sensitivity.
    METHODOLOGY:
    Thirty asymptomatic participants were assessed and randomly allocated to either a control, sham or mobilization group, where they were all given a neurodynamic test and ROM was assessed.
    RESULTS:
    The results showed that the mobilization group had the greatest and most significant increase in ROM with Change-Left p < 0.05 and Change-Right p < 0.05 compared against the control group, and Change-Left p < 0.01 and Change-Right p < 0.05 compared against the sham group.
    CONCLUSIONS:
    This study has highlighted that, as expected, cervical mobilization has an effect at reducing upper limb neural mechanical sensitivity. However, there may be other factors interacting with neural mechanosensitivity outside of somatic influences such as psychological expectation bias. Further research could utilize the methodology employed here, but with other treatment areas to help develop neural tissue research. In addition to this, further exploration of psychological factors should be made such as utilizing complex top-down cognitive processing theories such as the neuromatrix or categorization theories to help further understand cognitive biases such as the placebo effect, which is commonly ignored in osteopathic research, as well as other areas of science, and which would further complete a holistic perspective.

    Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review & Meta-Analysis

    Authors: Pamela M. Rist ScD, Audrey Hernandez MS, Carolyn Bernstein MD, Matthew Kowalski DC, Kamila Osypiuk MS, Robert Vining DC, Cynthia R. Long PhD, Christine Goertz DC, PhD, Rhayun Song RN, PhD, Peter M. Wayne PhD
    Published in: Headache. 2019 Apr;59 :532-542. doi: 10.1111/head.13501. Epub 2019 Mar 14.

    Abstract

    BACKGROUND:
    Several small studies have suggested that spinal manipulation may be an effective treatment for reducing migraine pain and disability. We performed a systematic review and meta-analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability.
    METHODS:
    PubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine-related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta-analytic methods were employed to estimate the effect sizes (Hedges' g) and heterogeneity (I2 ) for migraine days, pain, and disability. The methodological quality of retrieved studies was examined following the Cochrane Risk of Bias Tool.
    RESULTS:
    Our search identified 6 RCTs (pooled n = 677; range of n = 42-218) eligible for meta-analysis. Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability. Methodological quality varied across the studies. For example, some studies received high or unclear bias scores for methodological features such as compliance, blinding, and completeness of outcome data. Due to high levels of heterogeneity when all 6 studies were included in the meta-analysis, the 1 RCT performed only among chronic migraineurs was excluded. Heterogeneity across the remaining studies was low. We observed that spinal manipulation reduced migraine days with an overall small effect size (Hedges' g = -0.35, 95% CI: -0.53, -0.16, P < .001) as well as migraine pain/intensity.
    CONCLUSIONS:
    Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta-analysis, we consider these results to be preliminary. Methodologically rigorous, large-scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.