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ASSESSMENT OF LUMBAR SPINE KINEMATICS USING DYNAMIC MRI: A PROPOSED MECHANISM OF SAGITTAL PLANE MOTION INDUCED BY MANUAL POSTERIOR-TO-ANTERIOR MOBILISATION

Background: Postero-to-anterior (PA) mobilisation is employed to asses spinal segmental mobility, and although studies have described the kinematics of the movement, the direction of motion has not been well described.

Research question/s: What is the segmental motion of the lumbar spine during a PA mobilisation procedure using dynamic magnetic resonance imaging (MRI)?

Methodology:Subjects: 20 asymptomatic subjects (31.1 + 7.0 yrs; male  =  12, female  =  8).

Experimental procedure: Each subject underwent testing during sagittal plane MRI. An experienced physiotherapist applied PA mobilisation (Grade IV Maitland) at each segment L5 to L1. Images at rest and end range were examined.

Measures of outcome: Intervertebral motion (degrees; defined as the change in the intervertebral angle between the resting and end range vertebral positions) at each segment.

Main finding/s: • A PA force that is applied at one spinous process caused significant motion at the target vertebra.


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• A PA force that is applied at one spinous process caused motion which was propagated caudally and cranially.

• The observed motion at the target segment was always into extension.

Conclusion/s: A postero-anterior force that is applied at a single lumbar spinous process causes significant motion at that segment but also of the entire lumbar region.

Evidence based rating: 7/10

Clinical interest rating: 6.5/10

Type of study: Controlled laboratory study

Methodological considerations: Well conducted study

Keywords: lumbar segmental mobility, lumbar zygapophyseal joints, manual therapy, spine mobilisation

USEFULNESS OF BRONCHIAL REACTIVITY ANALYSIS IN THE DIAGNOSIS OF BRONCHIAL ASTHMA IN PATIENTS WITH BRONCHIAL HYPERRESPONSIVENESS

Background: It is well established that not all patients with bronchial hyperresponsiveness are asthmatic, and bronchial challenge tests can perhaps be used to determine which of these subjects are asthmatic.

Research question/s: Which bronchial reactivity indices can identify bronchial asthma in patients with airway hyperresponsiveness?

Methodology:Subjects: 88 patients with bronchial hyperresponsiveness (+ve response to histamine bronchial challenge ⩾20% fall in …

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