Jean-Yves Maigne

Mechanism of action of spinal manipulative therapy

Spinal manipulative therapy (SMT) acts on the various components of the vertebral motion segment. SMT distracts the facet joints, with faster separation when a cracking sound is heard. Intradiscal pressure may decrease briefly. Forceful stretching of the paraspinal muscles occurs, which induces relaxation via mechanisms that remain to be fully elucidated. Finally, SMT probably has an inherent analgesic effect independent from effects on the spinal lesion. These changes induced by SMT are beneficial in the treatment of spinal pain but short-lived. To explain a long-term therapeutic effect, one must postulate a reflex mechanism, for instance the disruption of a pain-spasm-pain cycle or improvement of a specific manipulation-sensitive lesion, whose existence has not been established to date.

Systematic review of manual therapies for nonspecific neck pain

OBJECTIVE To evaluate the effectiveness of manual therapies in the treatment of nonspecific neck pain. MATERIALS AND METHODS Medline and the Cochrane Library were searched for randomized controlled trials of manual therapy or mobilization, used alone or with exercises to treat pain and functional impairment related to nonspecific neck pain. Cochrane Back Review Group criteria were used to assess the quality of the trials and the level of evidence (unclear, limited, moderate, or high) for short-, medium-, and long-term effects. RESULTS Of 27 identified trials, 18 were of high quality. In acute neck pain, effective treatments were thoracic manipulation combined with electrothermal therapy in the short term and cervical manipulation in the long term. In chronic neck pain and neck pain of variable duration, both pain and function improved consistently at all follow-up time points. None of the manual therapies used alone or in combination was superior over the others. In the long term, exercises alone or combined with manual therapies were superior over manual therapies used alone. CONCLUSION Manual therapies contribute usefully to the management of nonspecific neck pain. The level of evidence is moderate for short-term effects of upper thoracic manipulation in acute neck pain, limited for long-term effects of neck manipulation, and limited for all techniques and follow-up durations in chronic neck pain.

Xiphodynia and prominence of the xyphoid process. Value of xiphosternal angle measurement: three case reports.

We describe three cases of xiphodynia in patients with prominence of the xyphoid process under the skin. The xiphosternal angle was 105°, 135°, and 120° in these three patients, respectively, compared to a mean of 172 ± 15° in 60 individuals without xiphodynia evaluated by computed tomography for another reason. The prominence of the xyphoid process caused discomfort and local irritation and was the source of the pain in all three patients. This abnormality should be looked for routinely in patients reporting xiphodynia.

Four cases of coccygeal disk calcification after cortivazol injection.

Chronic coccydynia can be treated with a glucocorticoid injection into the pain-causing intercoccygeal disk. We report four cases of calcifications within intercoccygeal disks previously injected with cortivazol. In two patients, the calcifications probably caused additional pain. Prednisolone acetate should be preferred over cortivazol for intercoccygeal disk injections.

Mecanismo de acción del tratamiento manipulativo vertebral

Spinal manipulative therapy (SMT) acts on the various components of the vertebral motion segment. SMT distracts the facet joints, with faster separation when a cracking sound is heard. Intradiscal pressure may decrease briefly. Forceful stretching of the paraspinal muscles occurs, which induces relaxation via mechanisms that remain to be fully elucidated. Finally, SMT probably has an inherent analgesic effect independent from effects on the spinal lesion. These changes induced by SMT are beneficial in the treatment of spinal pain but short-lived. To explain a long-term therapeutic effect, one must postulate a reflex mechanism, for instance the disruption of a pain-spasm-pain cycle or improvement of a specific manipulation-sensitive lesion, whose existence has not been established to date.