P. Vautravers

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.

Muscle oxygenation and intramuscular pressure related to posture and load in back muscles

BACKGROUND CONTEXT There is little information about the simultaneous changes of intramuscular pressure (IMP) and oxygen saturation (StO(2)) of the paraspinal muscle under various conditions of posture and load. PURPOSE To measure simultaneously and compare IMP and StO(2) across a range of static trunk postures commonly observed during normal work tasks. STUDY DESIGN A prospective study using a repeated-measure design in clinical setting. PATIENT SAMPLE Sixteen healthy young men with no history of back pain. OUTCOME MEASURES Simultaneous measurements of IMP by a flexible slit catheter and StO(2) by near infrared spectroscopy of the multifidus muscle were performed. METHODS The two measures were taken in six static posture tasks: standing upright and bending forward with and without load (20kg), bending backward and during a sustained isometric contraction (ie, Sorensen test). To compare the influence of the tasks on IMP and StO(2) variables, a one-way variance analysis with repeated measures was used. Spearmans rank correlation coefficient (rho) was determined between the two variables for each posture task. RESULTS We observed only a moderate but significant correlation between IMP and StO(2) values in upright standing and a trend in bending forward positions with load (p<.05). IMP increased in the bending backward position and showed the greatest increase during the Sorensen test. StO(2) decreased significantly during the Sorensen test, in the bending forward position with and without load bearing but did not in bending backward. CONCLUSION The simultaneous recording of IMP and StO(2) of the multifidus muscle allows a deeper insight of physiological events during various trunk postures. In the mutifidus muscle, there is no evident linear relationship between IMP and StO(2) values in various static postures of the trunk in young males. This preliminary study shows that IMP may play a role on StO(2) only in some circumstances, such as a prolonged endurance test or in a bending forward position with a significant load bearing.

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.

Manual medicine - osteopathy in France organization - education - fields of expertise.

Manual medicine-osteopathy (MMO) is of keen interest among young doctors, generalists and specialists alike. Through a discerning semiological approach, MMO allows non-pharmaceutical physical treatments to be proposed for many musculoskeletal pathologies. In March 2007, some manual therapies (e.g., osteopathy), until then the exclusive preserve of physicians, were recognized in France as a part of the field of professional expertise of non-physicians. This new opening of the manual medicine profession must make non-physicians and physicians aware of their responsibilities.

Médecine manuelle-ostéopathie et articulation sacro-iliaque

RésuméLes douleurs lombofessières représentent un motif fréquent de consultation. Certains praticiens de médecine manuelle rattachent ces douleurs à une dysfonction des articulations sacro-iliaques et proposent un traitement manipulatif. Cependant, la pertinence clinique des tests diagnostiques utilisés est faible, et l’efficacité des manipulations sacroiliaques insuffisamment démontrée.AbstractLumbosacral pain is a common reason for medical consultation. Some manual therapists relate it to the pain due to sacroiliac joint dysfunction and provide a manipulative treatment. However, the clinical relevance of diagnostic tests is low, and the effectiveness of sacroiliac joint manipulation is unproved.

Lipomatose épidurale et sciatalgie bilatérale. À propos d’un cas(revue de la littérature)

Resume La lipomatose epidurale ou lipodystrophie epidurale est une cause rare de compression medullaire ou radiculaire. Lee et al. [11] , des 1975, ont ete les premiers a rapporter l’association d’une lipodystrophie et d’un hypercorticisme induit. Depuis, une centaine d’observations ont ete publiees, liees le plus souvent a une corticotherapie. La graisse epidurale posterieure est un tissu de remplissage normalement present, mais qui peut devenir un element compressif en cas de canal lombaire etroit sans qu’il existe d’hypertrophie graisseuse. Nous rapportons le cas d’un patient obese qui presente une sciatalgie bilaterale liee, d’une part, a un canal lombaire etroit et, d’autre part, a une lipodystrophie.