Ramakrishnan Mani

Exposure to Whole-Body Vibration and Mechanical Shock: A Field Study of Quad Bike Use in Agriculture

OBJECTIVES The purpose of this study was to determine exposure to whole-body vibration (WBV) and mechanical shock in rural workers who use quad bikes and to explore how personal, physical, and workplace characteristics influence exposure. METHODS A seat pad mounted triaxial accelerometer and data logger recorded full workday vibration and shock data from 130 New Zealand rural workers. Personal, physical, and workplace characteristics were gathered using a modified version of the Whole Body Vibration Health Surveillance Questionnaire. WBVs and mechanical shocks were analysed in accordance with the International Standardization for Organization (ISO 2631-1 and ISO 2631-5) standards and are presented as vibration dose value (VDV) and mechanical shock (S(ed)) exposures. RESULTS VDV(Z) consistently exceeded European Union (Guide to good practice on whole body vibration. Directive 2002/44/EC on minimum health and safety, European Commission Directorate General Employment, Social Affairs and Equal Opportunities. 2006) guideline exposure action thresholds with some workers exceeding exposure limit thresholds. Exposure to mechanical shock was also evident. Increasing age had the strongest (negative) association with vibration and shock exposure with body mass index (BMI) having a similar but weaker effect. Age, daily driving duration, dairy farming, and use of two rear shock absorbers created the strongest multivariate model explaining 33% of variance in VDV(Z). Only age and dairy farming combined to explain 17% of the variance for daily mechanical shock. Twelve-month prevalence for low back pain was highest at 57.7% and lowest for upper back pain (13.8%). CONCLUSIONS Personal (age and BMI), physical (shock absorbers and velocity), and workplace characteristics (driving duration and dairy farming) suggest that a mix of engineered workplace and behavioural interventions is required to reduce this level of exposure to vibration and shock.

Interrater reliability of the craniocervical flexion test in asymptomatic individuals--a cross-sectional study.

OBJECTIVE The objective of this study was to evaluate interrater reliability of the craniocervical flexion test (CCFT) on asymptomatic subjects. METHODS A cross-sectional repeated-measures study design was used. Thirty asymptomatic subjects (15 men and 15 women; mean age, 33.7 years; range, 22-48 years) were recruited for the study. Subjects were positioned in supine lying with a pneumatic pressure sensor of the pressure biofeedback unit placed under the neck. Subjects performed 3 trials of craniocervical flexion with each trial consisting of 5 incremental stages (22, 24, 26, 28, and 30 mm Hg) guided through feedback from the pressure dial of the pressure biofeedback unit. All the trials were scored simultaneously by 2 raters. The outcome measure was the activation score-the maximum pressure (above baseline 20 mm Hg) that was achieved and held in a steady manner for 10 seconds. Intraclass correlation coefficient (ICC 3,1) was analyzed using the 2 repeated scores out of 3 trials for either rater. RESULTS Interrater reliability (ICC) for the CCFT was 0.91 (95% confidence interval, 0.83-0.96). There was a reasonable agreement on the Bland-Altman plot confirming high reliability of the test. CONCLUSION The study has shown high interrater reliability when 2 raters simultaneously scored the CCFT trials in asymptomatic individuals.

Short term effectiveness of neural sliders and neural tensioners as an adjunct to static stretching of hamstrings on knee extension angle in healthy individuals: A randomized controlled trial

OBJECTIVE To investigate the added benefit of nerve-biased interventions over static stretching in hamstring flexibility and to compare the effectiveness of two types of nerve-biased interventions over a week. DESIGN Three-arm assessor-blinded randomized controlled trial. SETTING University Laboratory. PARTICIPANTS Sixty healthy individuals (mean age = 22 ± 2.4 years) with reduced hamstring flexibility were randomized to three groups who received static stretching and neurodynamic sliders (NS-SS); static stretching with neurodynamic tensioner (NT-SS) and static stretching (SS) alone. OUTCOME MEASURE Knee extension angle (KEA) in degrees. RESULTS Baseline characteristics including demographic, anthropomorphic and KEA between groups were comparable. A significant interaction was observed between group (intervention) and time, [F (2,114) = 3.595; p = 0.031]. Post-hoc pairwise comparisons analyses revealed significant differences at post-intervention measurement time point between NS-SS and SS (mean difference: -6.8; 95%CI = -12, -1.5; p = 0.011) and NT-SS and SS (mean difference: -11.6; 95%CI = -16.7, -6.3; p < 0.001). However there was no significant difference between NS-SS and NT-SS groups (mean difference: 4.8; 95%CI = 0.4, 9.9; p = 0.074). CONCLUSIONS Neural sliders and tensioners are both effective in increasing hamstring flexibility as an adjunct to static hamstring stretching when compared to static stretching alone. No neural mobilization technique proved to be superior over another. CLINICAL TRIAL REGISTRATION This clinical trial is registered in Clinical Trials Registry- India (CTRI) with registration number CTRI/2012/05/002619.

The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis: A systematic review and meta-analysis

Objective: To determine whether manual therapy or exercise therapy or both is beneficial for people with hip osteoarthritis in terms of reduced pain, improved physical function and improved quality of life. Methods: Databases such as Medline, AMED, EMBASE, CINAHL, SPORTSDiscus, PubMed, Cochrane Library, Web of Science, Physiotherapy Evidence Database, and SCOPUS were searched from their inception till September 2015. Two authors independently extracted and assessed the risk of bias in included studies. Standardised mean differences for outcome measures (pain, physical function and quality of life) were used to calculate effect sizes. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for assessing the quality of the body of evidence for each outcome of interest. Results: Seven trials (886 participants) that met the inclusion criteria were included in the meta-analysis. There was high quality evidence that exercise therapy was beneficial at post-treatment (pain-SMD-0.27,95%CI-0.5to-0.04;physical function-SMD-0.29,95%CI-0.47to-0.11) and follow-up (pain-SMD-0.24,95%CI- 0.41to-0.06; physical function-SMD-0.33,95%CI-0.5to-0.15). There was low quality evidence that manual therapy was beneficial at post-treatment (pain-SMD-0.71,95%CI-1.08to-0.33; physical function-SMD-0.71,95%CI-1.08to-0.33) and follow-up (pain-SMD-0.43,95%CI-0.8to-0.06; physical function-SMD-0.47,95%CI-0.84to-0.1). Low quality evidence indicated that combined treatment was beneficial at post-treatment (pain-SMD-0.43,95%CI-0.78to-0.08; physical function-SMD-0.38,95%CI-0.73to-0.04) but not at follow-up (pain-SMD0.25,95%CI-0.35to0.84; physical function-SMD0.09,95%CI-0.5to0.68). There was no effect of any interventions on quality of life. Conclusion: An Exercise therapy intervention provides short-term as well as long-term benefits in terms of reduction in pain, and improvement in physical function among people with hip osteoarthritis. The observed magnitude of the treatment effect would be considered small to moderate.

The Influence of Body Mass on Whole-Body Vibration: A Quad-Bike Field Study

Objectives: The aim of this field study was to explore the relationship between body mass and quad bike induced whole-body vibration (WBV) exposure in a group of New Zealand rural workers. Methods: WBV exposure was recorded using a seat pad mounted tri-axial accelerometer while rural workers (n=34) were driving a quad bike for approximately half an hour on a pre-marked track on farm terrain. Personal factors such as age, height and quad bike driving experience were also surveyed and included as co-variates. Vibration dose value (VDV) was calculated by analyzing the recorded raw vibration data samples (n=34) using vibration analysis software and corrected to a one hour equivalent exposure for further statistical analysis. To evaluate for the relationship between variables of interest (body mass, height, age and driving experience) and one hour VDVZ (1hrVDVZ), univariate and multivariate linear regression analysis were conducted. Results: Mean 1hrVDVZ was 13.2 m/s 1.75 exceeded the VDV exposure action value of 9.1 m/s 1.75 . Univariate analysis 2 = 0.340) significantly (p < 0.0003) associated with 1hrVDVZ while age, body height and quad bike driving experience were not. In a multivariate backward linear analysis body mass, height, and experience combined to explain 38% (R 2 = 0.376) of the variance in 1hr VDVZ, however, only body mass (p= 0.0004) demonstrated statistical significance. Conclusion: Body mass is significantly and negatively associated with quad bike induced WBV (1hrVDVZ) in a group of New Zealand rural workers.

Does Acupuncture Alter Pain-related Functional Connectivity of the Central Nervous System? A Systematic Review

Acupuncture has been studied for several decades to establish evidence-based clinical practice. This systematic review aims to evaluate evidence for the effectiveness of acupuncture in influencing the functional connectivity of the central nervous system in patients with musculoskeletal pain. A systematic search of the literature was conducted to identify studies in which the central response of acupuncture in patients with musculoskeletal pain was evaluated by neuroimaging techniques. Databases searched were AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, Pubmed, SCOPUS, SPORTDiscuss, and Web of Science. Included studies were assessed by two independent reviewers for their methodological quality by using the Downs and Black questionnaire and for their levels of completeness and transparency in reporting acupuncture interventions by using Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) criteria. Seven studies met the inclusion criteria. Three studies were randomized controlled trials (RCTs) and four studies were nonrandomized controlled trials (NRCTs). The neuroimaging techniques used were functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). Positive effects on the functional connectivity of the central nervous system more consistently occurred during long-term acupuncture treatment. The results were heterogeneous from a descriptive perspective; however, the key findings support acupunctures ability to alter pain-related functional connectivity in the central nervous system in patients with musculoskeletal pain.

Determining the level of evidence for the effectiveness of spinal manipulation in upper limb pain: A systematic review and meta-analysis

BACKGROUND The use of spinal manipulation (SM) for upper limb pain has been advocated based on the concept of regional interdependence. However, its evidence has not been established. OBJECTIVE To determine the level of evidence for the effectiveness of SM in patients with upper limb pain as part of the concept of regional interdependence. METHODS MeSH and Key words representing two broad subject areas: SM and upper limb disorders were used to conduct an electronic search in sixteen electronic databases. Randomized controlled trials and/or controlled clinical trials investigating the effects of SM in patients with upper limb pain were included. Studies including pain in the neck or scapular region and those using spinal mobilization were excluded. Meta-analysis was conducted to examine the effects of SM on upper limb pain. The overall quality of evidence was assessed using the GRADE system. RESULTS Out of 3307 studies, six trials met inclusion criteria for this review. Of these, three studies were included in meta-analysis. Meta-analysis results suggested there were no statistical differences between SM and other interventions in the effects on reducing upper limb pain. The overall quality of evidence was very low. CONCLUSION The number of studies regarding the current topic is limited. There is very low quality evidence that SM is not better nor inferior than other interventions in the management of upper limb pain.

Measureable changes in the neuro-endocrinal mechanism following spinal manipulation

The autonomic nervous system and the hypothalamic-pituitary-adrenal axis have been shown to be dysfunctional in a number of chronic pain disorders. Spinal manipulation is a therapeutic technique used by manual therapists, which may have widespread neuro-physiological effects. The autonomic nervous system has been implicated to modulate these effects. A theory is proposed that spinal manipulation has the potential to be used as a tool in restoring the autonomic nervous system balance. Further, it is also hypothesised that through its anatomical and physiological connections, the autonomic nervous system activity following a thoracic spinal manipulation may have an effect on the hypothalamic-pituitary-adrenal axis and therefore pain and healing via modulation of endocrine and physiological processes. To substantiate our hypothesis we provide evidence from manual therapy studies, basic science and animal studies. According to the proposed theory, there will be measurable changes in the neuro-endocrinal mechanisms following a thoracic spinal manipulation. This has far-reaching implications for manual therapy practice and research and in the integration of spinal manipulation in the treatment of a wide array of disorders.

The Influence of Age, Sex and Body Mass Index on the Effectiveness of Brisk Walking for Obesity Management in Adults: A Systematic Review and Meta-Analysis

BACKGROUND Brisk walking is the most popular activity for obesity management for adults. We aimed to identify whether participant age, sex and body mass index (BMI) influenced the effectiveness of brisk walking. METHODS A search of 9 databases was conducted for randomized controlled trials (RCTs). Two investigators selected RCTs reporting on change in body weight, BMI, waist circumference, fat mass, fat-free mass, and body fat percentage following a brisk walking intervention in obese adults. RESULTS Of the 5072 studies screened, 22 met the eligibility criteria. The pooled mean differences were: weight loss, -2.13 kg; BMI, -0.96 kg/m2; waist circumference, -2.83 cm; fat mass, -2.59 kg; fat-free mass, 0.29 kg; and body fat percentage, -1.38%. Meta-regression of baseline BMI showed no effect on changes. CONCLUSIONS Brisk walking can create a clinically significant reduction in body weight, BMI, waist circumference, and fat mass for obese men and women aged under 50 years. Obese women aged over 50 years can achieve modest losses, but gains in fat-free mass reduce overall change in body weight. Further research is required for men aged over 50 years and on the influence of BMI for all ages and sexes.

Neuroendocrine Response Following a Thoracic Spinal Manipulation in Healthy Men

&NA; • STUDY DESIGN: Controlled laboratory study. • BACKGROUND: Spinal manipulation (SM) can trigger a cascade of responses involving multiple systems, including the sympathetic nervous system and the endocrine system, specifically, the hypothalamic‐pituitary axis. However, no manual therapy study has investigated the neuroendocrine response to SM (ie, sympathetic nervous system‐hypothalamic‐pituitary axis) in the same trial. • OBJECTIVE: To determine short‐term changes in sympathetic nervous system activity, heart rate variability, and endocrine activity (cortisol, testosterone, and testosterone‐cortisol [T/C] ratio) following a thoracic SM. • METHODS: Twenty‐four healthy men aged between 18 and 45 years were randomized into 2 groups: thoracic SM (n = 12) and sham (n = 12). Outcome measures were salivary cortisol (micrograms per deciliter), salivary testosterone (picograms per milliliter), T/C ratio, heart rate variability, and changes in oxyhemoglobin concentration of the right calf muscle (micromoles per liter). Measurements were done before and at 5 minutes, 30 minutes, and approximately 6 hours after intervention. • RESULTS: A statistically significant group‐by‐time interaction was noted for T/C ratio (P<.05) and salivary cortisol (P<.01) concentrations. Significant between‐group differences were noted for salivary cortisol concentration at 5 minutes (mean difference, 0.35; 95% confidence interval: 0.12, 0.6; interaction: P<.01) and for T/C ratio at 6 hours postintervention (mean difference, ‐0.09; 95% confidence interval: ‐0.16, ‐0.04; P = .02). However, SM did not differentially alter oxyhemoglobin, testosterone, or heart rate variability relative to responses in the sham group. • CONCLUSION: Thoracic SM resulted in an immediate decrease in salivary cortisol concentration and reduced T/C ratio 6 hours after intervention. A pattern of immediate sympathetic excitation was also observed in the SM group. • KEY WORDS: autonomic nervous system, cortisol, spinal manipulation, sympathetic nervous system, testosterone