Musoro wemusoro unonzi hutambudzi hwemusoro hunokonzerwa nehutano hwepfungwa pachahwo. Iyo mitatu mitatu yepfungwa huru yepamusoro misoro inosanganisira, migraine, marwadzo emusoro-soro uye misoro yemasumbu. Kutambudzika kwemukoko chiratidzo chinorwadza uye chinoparadza chinogonawo kuitika semugumisiro weimwe chikonzero chinokonzera. Musoro wemusoro unonzi hutambudzi hwemusoro hunoitika nekuda kwekukuvara uye / kana mamiriro. Kusaruramisa kwemusana, kana kugunun'una, pamwe nemucheto wemutsipa, kana mutsipa, kazhinji kunobatanidza nezviratidzo zvakasiyana-siyana zvepfungwa.

 

Cervicogenic misoro yechipfuva ndeye musoro wechipiri unokonzerwa nekukuvadzwa uye / kana chiitiko chinokonzera zvivako zvakakomberedza zvepervical spine, kana mutsipa. Vazhinji vashandi vehutano vacharumbidza kushandiswa kwezvinodhaka / mishonga kuti ibatsire kuvandudza misoro, zvisinei, dzimwe nzira dzakasiyana-siyana dzokurapa dzinogona kushandiswa zvakanaka uye dzinoshandiswa kugadzirisa musoro wechipiri. Chinangwa chehurukuro inotevera ndechekuratidzira hutachiwana hwepamusoro hwechibereki uye chepamusoro chekutengesa thoracic maererano nekugadzirisa nekuita muviri muvarwere vane cervicogenic musoro.

 

Urefu hweCervical uye Upper Thoracic Manipulation Versus Mobilization uye Kudzidzira Muzvirwere neCervicogenic Headache: Multi-Center Randomized Clinical Trial

 

ngovepo

 

• Background: Kunyange zvazvo inowanzoshandiswa nzira dzekushandisa, hapana tsvakurudzo yakanyatsofananidza nekubudirira kwechirwere chechirchi uye chekunyengedzera kwekunyaradza nekuita maitiro muvanhu vane cervicogenic headache (CH). Chinangwa chechidzidzo ichi chaiva chokuenzanisa migumisiro yekushandiswa kwekukurudzira nekuita maitiro muvanhu vane CH.
• Nzira: Vane zana negumi vatori vechikamu (n? =? 110) neCH vakasarudzika kuti vagamuchire ese emumuromo uye echironda kunyengedza (n? =? 58) kana kuunganidza uye kurovedza muviri (n? =? 52). Mhedzisiro mhedzisiro yaive kusimba kwemusoro sekuyerwa neNumeric Pain Rating Scale (NPRS). Sekondari mhedzisiro yaisanganisira kuwanda kwemusoro, kutemwa nemusoro, kuremara sekuyerwa neNeck Disability Index (NDI), kunwa mishonga, uye Global Rating yeKushandura (GRC). Nguva yekurapa yaive mavhiki e4 nekutevera-kuongorora pa1 vhiki, mavhiki e4, uye mwedzi mitatu mushure mekutanga kurapwa chikamu. Chinangwa chekutanga chakaongororwa ne3-nzira yakavhenganiswa-modhi ongororo yemusiyano (ANOVA), neboka rekurapa (kumisikidza maringe nekusimudzira uye kurovedza muviri) senge iri pakati pezvidzidzo zvinosiyana uye nguva (yekutanga, svondo rimwe, mavhiki mana nemwedzi mitatu) se izvo zviri mukati mezvidzidzo zvinosiyana.
• Results: Iyo 2X4 ANOVA yakaratidza kuti vanhu vane CH avo vakagamuchira zvese remuromo wechibereko uye thoracic kudzvinyirira vakasangana nekudzikisira kwakakura kwazvo mukushungurudzika kwemusoro (p?
• Mhedziso: Zvidzidzo zvitanhatu kusvika masere zvepamusoro pemakondomu nepamusoro-soro thoracic zvakaratidzwa kuti dzakagadzirisa kupfuura kukurudzira uye kurovedza muviri mune varwere vane CH, uye migumisiro yakachengetwa pamwedzi we3.
• Trial registration: NCT01580280 April 16, 2012.
• Keywords: Cervicogenic headache, Kushungurudza kwepfungwa, Kukurudzira, High velocity low amplitude thrust

 

Dr. Alex Jimenez's Insight

Mukufananidza nemusoro wemusoro, zvakadai migraine, musana wemasumbu uye kushungurudzika kwemusoro-musoro, humwe hutano hunoonekwa sehutambudzi hwemusoro hunokonzerwa nedzimwe chirwere kana chirwere. Muchiitiko che cervicogenic musoro, chinokonzera kurwadziwa kwepamusoro kunokonzerwa nekukuvadzwa uye / kana mamiriro pamwe nechepervical spine uye zvivako zvaro zvakapoteredza, kusanganisira vertebrae, intervertebral discs uye zvinyoro zvishoma. Mukuwedzera, vashandi vazhinji vezvehutano vanotenda kuti musoro wepamusoro unogona kugoverwa nehutano hwehutano mumutsipa wekervical, kana mutsipa. Cervicogenic misoro yechirwere inofanira kuve iyo inobva kune zviratidzo uye inogona kusiyana zvichienderana nemurwere. Chiropractic kuchengetedza inoshandisa maginha ekugadzirisa uye maitiro ekushandisa kuitira kunyatsogadzirisa chimiro chepakutanga uye basa remutsana, zvichibatsira kuderedza kushungurudzika uye kuomanikidza kuti uwedzere zviratidzo zvepachiviri chepervicogenic, pakati peimwe mhando yemusoro. Kuchengetedza chiropractic kunogona kushandiswawo kubatsira kubatsira kubata misoro yemusoro, yakadai semigraines.

 

kumashure

 

Iyo International Classification ye Headache Disorders inotsanangura cervicogenic headache (CH) se, musoro unokonzerwa nekusagadzikana kwecervical spine uye chikamu chayo bony, disc, uye / kana zvinyoro zvinyama zvinhu, kazhinji asi zvisingaite zvinowirirana nekurwadziwa kwemutsipa. [1 ] (p. 760) Kuwanda kweC CH kwakanzi kuri pakati pe0.4 ne20% yemusoro wevanhu [2, 3], uye yakakwira se53% mune varwere vane misoro mushure mekukuvara kwechiplash [4]. Izvo zvinonyanya kufadza CH zvinowanzo sanganisira: unilatality yemusoro kurwadziwa pasina divi-kusuduruka, kukwirisa kwekutambudzika nekunze kumanikidza pamusoro peiyo ipsilateral kumusoro mutsipa, mashoma emumuromo erudzi rwekufamba, uye kukonzera kwekurwiswa nemhando dzakasiyana dzinoomarara kana dzakatsiga kufamba kwemutsipa [4, 5].

 

Vanhu vane CH vanowanzobatwa nemishonga yepelin manipulative iyo inosanganisira kukurudzira uye kushandiswa [6]. Kubatana kwepamuviri kunosanganisira zvishoma nezvishoma, zvine rhythmical, zvisingagoni kushandiswa asi kushandiswa kunosanganisira high-velocity low-amplitude trust techniques. [7] Mukudzokorora kwezvinoitika, Bronfort uye vashandi pamwe chete vakatsanangura kuti mushonga wepelinical manipulative therapy (zvose kukurudzira uye kushandiswa) zvakashanda mukubata kwevakuru vane CH [8]. Zvisinei, havana kuudza kana kushandiswa kwakaguma nemigumisiro yakakwirira ichienzaniswa nekugadziriswa kwevatungamiri vehuwandu hwevanhu.

 

Tsvakurudzo dzinoverengeka dzakatsvaga mhedzisiro yekumanikidza kwepelinha mune manejimendi CH [9-13]. Haas et al. [10] akaongorora kushanda kwekushomeka kwechibereko mune zvidzidzo neCH. Jull et al. [11] yakaratidza kushanda kwekurapa kwekurapa kwekunyengera uye / kana kurovedza muviri mukutungamira kweCH. Nekudaro iro rekunyepedzera rerapi boka raisanganisira kudzvinyirira uye kuunganidza saka hazvigone kutsanangurwa kana mhedzisiro inobatsira yaive mhedzisiro yekumanikidza, kukurudzira kana kusangana.

 

Zvidzidzo zvishoma zvakaongorora mabhenefiti ekugadzirisa pamwe nekumisikidza manejimendi ekurwadziwa kwemutsipa wemutsipa uine kana pasina kurovedza muviri. Zvisinei, hapana zvidzidzo zvakanyatsofananidza migumisiro yekunyengera pamwe nekuunganidza uye kurovedza muviri kune varwere vane CH. Tichifunga nezve njodzi dzinofungidzirwa dzekumanikidza [14], zvakakosha kuti uone kana kumanikidza kunoguma nemhedzisiro yakagadziriswa zvichienzaniswa nekusimudzira manejimendi evarwere vane CH. Naizvozvo, chinangwa cheichi chisina kujairika chemakiriniki kuyedzwa kwaive kuenzanisa mhedzisiro yekumanikidza pamwe nekuunganidza uye kurovedza muviri mune varwere vane CH. Isu takafungidzira kuti varwere vanogamuchira kumanikidza pamusoro pe16-vhiki yekurapwa nguva vaizoona kuderedzwa kukuru mukusimba kwemusoro, kuwanda kwemusoro, kureba kwemusoro, kuremara, uye kunwa kwemushonga mukutevera-kwemwedzi mitatu kupfuura varwere vanowana remuromo wechibereko uye thoracic kukurudzira pamwe nekurovedza muviri. .

 

nzira

 

Vakwikwidzi

 

Mune ino mizhinji-yepakati yakarongedzwa kiriniki kuyedzwa, akateedzana varwere vane CH vanopa kune 1 we8 ekurapa ekurapa ekurapa makiriniki kubva kunzvimbo dzakasiyana siyana dzenzvimbo (Arizona, Georgia, New York, Ohio, Pennsylvania, South Carolina) vakanyoreswa pamusoro pemwedzi we29. nguva (kubva Kubvumbi 2012 kusvika Nyamavhuvhu 2014). Kuti varwere vakodzere kukodzera, vaifanirwa kupa nehutachiona hweC CH maererano neyakaongororwa nzira yekuongorora [5] yakagadzirwa neCervicogenic Headache International Study Group (CHISG) [5, 18, 19]. CH yakarongedzwa zvinoenderana ne''major criteria '' (isingasanganise humbowo hwekusimbisa neanesthetic anesthetic blockades) uye pain musoro wemarwadzo maitiro eCHISG. Naizvozvo, kuitira kuti iverengerwe muchidzidzo, varwere vaifanirwa kuratidza zvese zvinotevera maitiro: (1) unilaterality yemusoro wekurwadziwa pasina parutivi, kutanga kumusoro kwepashure mutsipa kana nzvimbo ye occipital, pakupedzisira ichipararira kune oculofrontotemporal nzvimbo pane chiratidzo chechiratidzo, (2) kurwadziwa kunokonzerwa nekufamba kwemutsipa uye / kana nzvimbo dzakaomarara, (3) yakaderedzwa nzira yekufamba mumutsipa wechibereko [20] (kureva., pasi pe kana kuenzana ne32 yekurudyi kana kuruboshwe kwekutenderera pane Flexion-Rotation Bvunzo [21 23], (4) marwadzo akakonzerwa nekumanikidza kwekunze pamusoro peimwechete yepamusoro yezvibereko zvechibereko (C0-3), uye (5) zvine mwero kusvika pakurwadza kwakanyanya, kusiri kurova uye kusiri kwekupembedza. Uye zvakare, vatori vechikamu vaifanira kuve nemusoro wemusoro weinenge 1 pavhiki kweinenge mwedzi mitatu, hushoma hwemusoro kusimba kwekutambudzika kwemapoinzi maviri (3 0 pachikero cheNPRS), hushoma hurema hwe10% kana chikuru (kureva., gumi mapoinzi kana akakura pachiyero che20 10 NDI), uye uve pakati pe0 ne50 hongu rs zera.

 

Varwere vaisarudzwa kana vachiratidza mamwe maziso emusoro (kureva, migraine, TTH), anotambura nemusoro wepamusoro, kana kuratidza chero mapegi matsvuku (kureva, chirwere, kuputika, zvirwere zvemagetsi, rheumatoid arthritis, osteoporosis, kuregererwa kwehutano hweropa kupfuura 140 / 90 mmHg, nhoroondo yakareba ye steroid kushandiswa, nezvimwewo), yakapiwa zviratidzo zviviri kana zvinopfuura zvakanaka zveurourologic zvinokonzerwa nehutano hwemitsipa inokonzera (musimba utera hunobatanidza boka guru remashure rekumusoro, rakaderera kumusoro kwepamusoro zvakadzika tendon reflex, kana kuderedza kana kusisipo kuti pinprick chero ipi zvayo yepamusoro kune dermatome), yakaratidzwa nekuongororwa kwechirwere chepervical stenosis, yakaratidzwa kumativi ose ekumusoro kwezviratidzo, yakanga ine uchapupu hwehutachiona hwehutano hwekubatana (hyperreflexia, kushungurudzika kwemanzwiro muruoko, kushaya musimba kuputsika kwemaoko, kusazorora panguva yekufamba , nystagmus, kurasikirwa kwemaonero anooneka, kusagadzikana kwekunzwa kwechiso, kushandurwa kunzwisisika, kuvapo kwemafuro echirwere es), aine nhoroondo yekuputika kwechiplash mukati mevhiki dzakatangira 6, aive nekuvhiyiwa kwepamusoro kumusoro kana mutsipa, akanga agamuchira kurapwa kwemusoro kana mutsipa kubva kune mumwe mushandi mukati memwedzi wapfuura, wakagamuchira kurapwa muviri kana chiropractic mishonga yemusoro kana kurwadziwa kwemutsipa mukati memwedzi yakapfuura ye3, kana kuti kutongerwa mutemo pamusoro pemusoro wavo kana mutsipa.

 

Mabhuku anonyanya kuitika anoratidza kuti kusati kwamboita kushandiswa kwechiberekero chekuita mishonga yechirungu haikwanise kuona avo vari pangozi yezvakakomba zvemapurisa kubva kumucherechedzo wechibereki [24, 25], uye zviratidzo chero zvipi zvayo zvinowanikwa munguva yekuedza kushandiswa kwepamberi zvingave zvisina kufanana nekuchinja mukubuda kweropa mu iro reteralal artery [26, 27]. Nokudaro, kusati kwamboita kushandiswa kwemakemikari yeropa rekare kusati kwaitwa muchidzidzo ichi; zvisinei, kuongorora mibvunzo yechipical artery disease kwaifanira kuva isina [24, 28, 29]. Ichi chidzidzo chakabvumirwa neInstitutional Review Board paLong Island University, Brooklyn, NY. Chidzidzo chacho chakanyoreswa pawww.clinicaltrials.gov nechirongwa chekuedza NCT01580280. Vose varwere vakaudzwa kuti vaizogadziriswa kana kugadziriswa uye kubhabhatidza uye vazopa mvumo yakagadziriswa vasati vanyora mubvunzo.

 

Kurapa Vanachiremba

 

Vanegumi nevaviri varapi vemuviri (kureva zera makore makumi matanhatu nematanhatu, SD 36.6) vakapinda mukuendeswa kwekurapa kwevarwere muchidzidzo ichi. Ivo vaive neavhareji ye5.62 (SD 10.3, yakatangira 5.66 3 makore) makore ehutano hwekiriniki, uye vese vakapedza chirongwa che20 h post-graduate certification chirongwa icho chaisanganisira kudzidziswa kunoshanda mumawoko ehunyanzvi anosanganisira kushandisa kwecervical uye thoracic manipulation. Kuchengetedza kwese kuongororwa, mhedzisiro kuongororwa, uye maitiro ekurapa akaenzaniswa, vese varapi vemuviri varikubata vaidikanwa kuti vadzidze bhuku rezviyero zvevashandisi uye vatore chikamu muchikamu chekudzidzisa che60 h nemupurisa mukuru.

 

Nzira dzekuongorora

 

Vese varwere vakapa ruzivo rwehuwandu, vakapedza iyo Neck Pain Medical Screening Mubvunzo, uye vakapedzisa akati wandei wega-chirevo matanho, akateverwa nenhoroondo yakaenzana uye kuongororwa kwepanyama pakutanga. Kuzvitaurira-zviyero zvaisanganisira kusimba kwemusoro sekuyerwa neNPRS (0 10), iyo NDI (0 )50), frequency frequency (huwandu hwemazuva ane musoro muvhiki rapfuura), kutemwa kwemusoro (maawa ese emusoro mukupedzisira vhiki), uye kunwa mishonga (nhamba yenguva iyo murwere akange atora marwadzo kana kupfuura-the-counter mishonga yekurwadziwa muvhiki yapfuura).

 

Chirongwa chemuviri chaiyo chakanga chisingarevi kune, asi chakakonzera zviyero zveC1-2 (atlanto-axial joint) kwete kurudyi uye kuruboshwe rwendo ROM uchishandisa Flexion-Rotation Test (FRT). Kuvimbika kwepakati-rater yeFR yakawanikwa yakaisvonaka (ICC: 0.93; 95% CI: 0.87, 0.96) [30].

 

Migumisiro yeMitemo

 

Mhedzisiro mhedzisiro chiyero chakashandiswa muchidzidzo ichi yaive yemurwere kusimba kwemusoro sekuyerwa neNPRS. Varwere vakabvunzwa kuti varatidze huwandu hwepakati pekurwadziwa kwepfungwa pamusoro pevhiki yapfuura vachishandisa 11-poindi chiyero kubva pa0 ( no pain ) kusvika 10 (painrworst imaginableable) pakutanga, 1-vhiki, 1-mwedzi, uye 3-mwedzi zvichitevera kekutanga kurapwa chikamu [31]. Iyo NPRS chishandiso chakavimbika uye chakaringana chekutarisa kurwadziwa kwakanyanya [32-34]. Kunyangwe pasina dhata iripo kune varwere vane CH, iyo MCID yeNPRS yakaratidzirwa kuve 1.3 mune varwere vane mechanical mitsipa kurwadziwa [32] uye 1.74 mune varwere vane akasiyana akasiyana maronda asingagumi mamiriro [34]. Naizvozvo, isu takasarudza kungosanganisira varwere vane chikamu cheNPRS chemapoinzi maviri (2%) kana kupfuura.

 

Sekondari mhedzisiro matanho aisanganisira iyo NDI, iyo Global Kukosha kweKuchinja (GRC), kutemwa nemusoro, kuwanda kwemusoro, uye kudya kwemushonga. Iyo NDI ndiyo chishandiso chinonyanya kushandiswa pakuongorora kuremara kwakazvimirira muvarwere vane kurwadziwa kwemutsipa [35-37]. Iyo NDI ibhuku rekuzvibvunza-mibvunzo ine gumi-zvinhu zvakatemwa kubva pa10 (hapana hurema) kusvika kushanu (hurema hwakazara) [0]. Mhinduro dzenhamba dzechinhu chimwe nechimwe dzakapfupikiswa nezvibodzwa zvese zviri pakati pe38 ne0; zvisinei, vamwe vaongorori vakasarudza kuwedzera mamaki matsva nemaviri, vobva vazivisa NDI pachiyero che 50 0% [100, 36]. Zvikoro zvepamusoro zvinomiririra huwandu hwekuremara. Iyo INI yakawanikwa iine yakanakisa bvunzo-kudzokorodza kuvimbika, yakasimba kuvaka kuvimbika, kusimba kwemukati kusagadzikana uye kupindura kwakanaka pakuongorora kuremara kune varwere vane michina yemutsipa kurwadziwa [39], remuromo radiculopathy [36, 33], whiplash inosanganisika kusagadzikana [40, 38, 41], uye musanganiswa wakasarudzika wemutsipa [42, 43]. Kunyangwe pasina zviongorori zvakaongorora psychometric zvimiro zveiyo NDI mune varwere vane CH, isu takasarudza kungoisa varwere chete vane NDI mamaki gumi (44%) kana kupfuura, nekuti ichi chibodzwa chakatemwa chinotora iyo MCID yeiyo NDI, iyo yakataurwa kuti inofungidzirwa ina, sere, uye mapfumbamwe mapoinzi (20 0) mune varwere vane musanganiswa wakasarudzika wemutsipa [50], mekutambudzika mutsipa [44], uye remuromo radiculopathy [45], zvichiteerana. Headache frequency yakayerwa sehuwandu hwemazuva ane musoro muvhiki rapfuura, kubva pa33 kusvika pamazuva manomwe. Kutemwa kwemusoro kwakayerwa seyakazara maawa ekurwadziwa nemusoro muvhiki rapfuura, aine nhanhatu nhanhatu dzinogona kuitika: (0) 7 1 h, (0) 5 2 h, (6) 10 3 h, (11) 15-4 h, (16) 20 5 h, kana (21) 25 kana anopfuura maawa. Kudya kwemishonga kwakayerwa sehuwandu hwenhambo dzenguva murwere atora mushonga kana kupfuura-the-counter analgesic kana anti-anogumbura mishonga muvhiki yapfuura yemusoro wavo, zvine sarudzo shanu: (6) kwete zvachose, (26) kamwe a vhiki, (1) kamwe chete pamazuva mashoma, (2) kamwe kana kaviri pazuva, kana (3) katatu kana kupfuura pazuva.

 

Varwere vakadzokera ku1-vhiki, 4-masvondo, uye mwedzi mizana ye3 kutevera apo zvakataurwa pamusoro apa zvakagadziriswa zvakare zvakare. Mukuwedzera, pa 1-vhiki, 4-masvondo uye 3-mwedzi inotevera, varwere vakapedzisa mubvunzo weCXC-GRC inotsanangurwa nechiyero chakatsanangurwa naJaeschke et al. [15] kuverenga maonero avo ekuvandudza basa. Nhamba yakakura kubva -46 (yakawanda kwazvo yakaipisisa) kusvika kune zero (inenge yakafanana) ku + 7 (yakawanda kwazvo zviri nani). Zvinyorwa zvinotsanangurwa zvekuwedzera kana kuvandudza zvinopiwa maitiro kubva -7 kusvika -1 uye + 6 kusvika + 1, maererano. MCID yeRCC haina kunyatsotaurwa asi huwandu hwe6 uye + 4 kakawanda hwave huri kuratidza kuchinja kwakanyatsonaka mumamiriro emurwere [5]. Zvisinei, zvinofanira kuonekwa kuti munguva ichangopfuura Schmitt naAbbott vakashuma kuti GRC inogona kusawirirana nekuchinja kwebasa muhuwandu hunova nekukuvadzwa kwechiuno neyemakumbo [46]. Zvose zvinogadziriswa matanho zvakakonzerwa nemunhu anoongorora asingaoni kugoverwa kweboka.

 

Pakushanya kwekutanga varwere vakapedza ese matanho emhedzisiro uye vakagamuchira yekutanga chikamu chekurapa. Varwere vakapedza zvikamu zvitanhatu zvekurapa zvekunyengedza kana kukurudzira pamwe chete nekurovedza muviri kwevhiki ina. Pamusoro pezvo, zvidzidzo zvakabvunzwa kana vakamboona zviitiko zvakashata major [6, 8] (kurohwa kana kusakwana kwehuropi) panguva yega yega yekutevera.

 

Randomization

 

Kutevera bvunzo yekutanga, varwere vaiwanzo kupihwa mukana wekubiridzira kana kukurudzira kana kurovedza muviri. Kugovaniswa kwakagoverwa kwakaitwa nekushandisa komputa-inogadzirwa yakasarudzika tafura yenhamba dzakagadzirwa nemunhu asina kubatanidzwa mukutora varwere pamberi pekutanga kwekudzidza. Mumwe nemumwe, akateedzana akaenzana manhamba emakadhi aine yakasarudzika kupihwa kwakagadzirirwa yega yega ye8 maseru ekuunganidza masosi. Iwo makadhi emakadhi akapetwa ndokuiswa mumavhopu akavharika akavharika. Vakapofomadzwa kuongororo yekutanga, murapi akavhura hamvuropu ndokuenderera mberi nekurapa zvinoenderana neboka rakapihwa. Varwere vakarairwa kuti varege kukurukura nezveimwe nzira yekurapa inogamuchirwa neyekuongorora murapi. Muongorori wekurapa akaramba ari bofu kune iro remurwere boka rekurapwa basa nguva dzese; zvisinei, zvichibva pachimiro chekupindira kwacho zvaisaita kupofomadza varwere kana kurapa varapi.

 

Manipulation Group

 

Manipulations anotarisa kurudyi uye kuruboshwe C1-2 mazwi uye maviri T1-2 mataurirwo akaitwa pane imwe chete yezvikamu zvitanhatu zvekurapa (Maonde. 6 uye? Na8) .1). Pane mamwe marapirwo ekurapa, varapi vanogona kudzokorora C2-2 uye / kana T1-2 manomano kana kunongedzera mamwe marondedzero emuzongoza (kureva, C1-2, C0-1, C2-3, T3-7, mbabvu 2 9) vachishandisa mashandisirwo . Kusarudzwa kwezvikamu zvepelinha kutariswa kwakasiiwa kungwaru kweanorapa uye yaive yakavakirwa pamubatanidzwa wemishumo yemurwere uye ongororo yebhuku. Kune ese ari maviri epamusoro emuromo wechibereko uye epamusoro thoracic manejimendi, kana pasina kubuda kana kutsemura ruzha rwakanzwikwa pakuedza kwekutanga, murapi akaisazve murwere uye akaita kechipiri kunyengera. Kuwanda kwekuedza kwe1 kwakaitwa pamurwere mumwe nemumwe zvakafanana nezvimwe zvidzidzo [9, 2-14]. Vanachiremba vakarairwa kuti manyorerwo acho anogona kunge achiperekedzwa nemisindo yakawanda inonzwika [50-53]. Varwere vakakurudzirwa kuchengetedza zvakajairwa zviitiko mukati memiganhu yekurwadziwa; zvisinei, kuunganidzwa uye kunyorerwa kwemaekisesaizi, kana chero kushandiswa kweimwe nzira, hazvina kupihwa kune iri boka.

 

 

 

Iko kukanganisa kunongedza C1-2 kwakaitwa nemurwere mu supine. Kune iyi nzira, murwere akasiyiwa posterior arch yeatlasi yakasangana neyekumashure chikamu cheiyo proximal phalanx yemurapi akasara wechipiri chigunwe achishandisa cradle hold . Kuti uwane masimba kuruboshwe kuruboshwe kweC1-2, murwere akaiswa pachishandiswa kuwedzera, posterior-anterior (PA) switch, ipsilateral side-bend uye contralateral side-shift. Ndichiri kuchengetedza chinzvimbo ichi, murapi akaita imwechete yakakwira-velocity, yakaderera-amplitude inokanda kumanikidza kuruboshwe atlanto-axial mubatanidzwa uchishandisa kurudyi kutenderera mune arc yakatarisana neziso rezasi uye kududzira kutafura (Fig. 1). Izvi zvakadzokororwa uchishandisa maitiro akafanana asi yakanangiswa kurudyi C1-2 kutaura.

 

Iko kukanganisa kunongedza T1-2 kwakaitwa nemurwere mu supine. Kune iyi nzira, murwere akamubata / maoko ake uye maoko ake epamberi pechipfuva nemagokora akaenderana munzira yepamusoro. Iye murapi akabata nzira dzekuyambuka dzeyepasi vertebrae yechinongedzo chinofamba chikamu neiyo yepamusoro simba uye yepakati phalanx yedhijitari yechitatu. Iyo yekumusoro lever yakaiswa munzvimbo yechinangwa chekufamba nekuwedzera kutenderera kure uye nerutivi-kukotamira kune murapi nepo ruoko rwepazasi rwakashandisa chirevo uye kutsauka kweridhi kuti uwane kutenderera uchienda uye padivi-kukomberedza nguva, zvichiteerana. Iyo nzvimbo yakaderera kune xiphoid maitiro uye costochondral marginal yemushandi yakashandiswa senzvimbo yekubatana pamusoro pevarwere elbows kuendesa kumanikidza mukati mekunze kune yekumashure nzira inotarisana neT1-2 bilaterally (Fig. 2).

 

Kukurudzira uye Kudzidzira Girasi

 

Kukurudzira kunongedzera kurudyi uye kuruboshwe C1-2 mataurirwo uye mbiri mbiri T1-2 mataurirwo akaitwa pane imwe chete yezvikamu zvitanhatu zvekurapa. Pane mamwe marapirwo ekurapa, varapi vanogona kudzokorora iyo C6-8 uye / kana T1-2 kukurudzira kana kunongedzera kumwe kutaura kwepamuviri (kureva, C1-2, C0 / 1, C2-3, T3-7, mbabvu 2 9) vachishandisa kukurudzira. . Kusarudzwa kwezvikamu zvepelinha kutariswa kwakasiiwa kungwaru kweanorapa uye yaive yakavakirwa pamubatanidzwa wemishumo yemurwere uye kuongororwa kwebhuku. Nekudaro, kuitira kuti udzivise kubatana kana kutarisisa kana ichienzaniswa neboka rekunyepedzera, varapi vakarairwa kuunganidza chikamu chimwe chechibereko (kureva, kurudyi uye kuruboshwe) uye chikamu chimwe chete chemutsipa kana rumbidzo pamusangano wega wega wekurapa.

 

Kubatana kunotarisana neC1-2 kutsanangurwa kwakaitwa nenzira yakajairika. Pamusana pegadziriro iyi, muongorori akaita imwe 30 s bout yebato rekunze unilateral grade IV PA mobilizations kumativi ekufambisa eC1-2 sezvakatsanangurwa naMaitland [7]. Nzira imwechete yakadzokororwa kune imwe 30 s bout kusvika kune imwe yakarurama paanlanto-axial joint. Mukuwedzera, uye pamusangano mumwe chete, kuunganidza kunotungamirirwa kune chepamusoro thoracic (T1-2) musana nemuviri wepamusoro wakaitwa. Nokuda kweiyo nzira, muongorori akaita chirongwa che 30 chepakati pegwaro re IV PA mobilizations kumativi ekufambisa a T1-2 sezvakatsanangurwa naMaitland [7]. Nokudaro, takashandisa 180 (kureva,, katatu 30 s zvinyorwa zvinosvika 2 Hz) kushandiswa kwekupedzisira kwepamusoro pamusoro wega yega yega yekugadziriswa. Zvinonzwisisika, hakuna humwe hutsika huno uchapupu huripo hunoratidza kuti nguva yakareba yekugadzirisa inokonzerwa nekuderedza kunorwadziwa kudarika nguva shoma kana maitiro ekugadzirisa [59, 60].

 

Cranio-cervical flexion Exercises [11, 61-63] yakaitwa nemurwere mu supine, nemabvi akakotama uye chinzvimbo chemusoro chakamisikidzwa nekuisa iyo craniocervical uye cervical spines munzvimbo yepakati, senge tambo pakati subject foreheadshuma nechaini yakanga yakatwasuka, uye tambo yakatwasuka kubva ku tragus yenzeve yakavhiringidza mutsipa kureba. Mhepo-yakazadza kumanikidza biofeedback unit (Chattanooga Group, Inc., Hixson, TN) yakaiswa suboccipitally kuseri kwemutsipa wemurwere uye preinflated kune yekutanga basiti ye20 mmHg [63]. Pamitambo yekurovedza, varwere vaidikanwa kuti vaite craniocervical flexion chiito (noda nod yemusoro, yakafanana nekuratidzira hongu) [63] uye kuyedza kutarisisa kumanikidza kwe22, 24, 26, 28, uye 30 mmHg kubva yekutanga yekuzorora ye20 mmHg uye kubata iyo nzvimbo yakatsiga ye10 s [61, 62]. Kuita kwekugutsurira kwakaitwa nehunyoro uye unononoka maitiro. Zororo gumi rakabvumidzwa pakati pemiyedzo. Kana iko kumanikidza kwakatsauka pazasi pechinodzvinyirirwa, iko kumanikidza hakuna kuitiswa kwakadzikama, kuchinjirwa neyekunyepera kushanduka (sternocleidomastoid kana anterior scalene) yakaitika, kana kudzorerwa kwemutsipa kwakacherechedzwa kusati kwapera kweiyo 10 s isometric hold, yaionekwa sekutadza [10]. Yekupedzisira yakabudirira tarisiro yekumanikidza yakashandiswa kuona yega yega murwere maitiro ekurovedza umo matatu seti e63 kudzokorora aine 3 s isometric kubata yakaitwa. Pamusoro pekusimudzira uye cranio-remuromo flexion kurovedza, varwere vaifanirwa kuita 10 min yekuenderera mberi yekudzivirira maitiro (kureva, kushandisa Therabands kana mahara mahuremu) kumhasuru dzebhandi repafudzi panguva yega yega yekurapa chikamu, mukati mekutsungirira kwavo, uye kunyanya kutarisa kune yepasi trapezius uye serratus anterior [10].

 

Sample Size

 

Muenzaniso wokukura uye simba kuverenga kwakaitwa uchishandura software kubva kuMGH Biostatistics Center (Boston, MA). Kuverenga kwaive kwakavakirwa pakuona mutsauko we 2-kana (kana 20%) muNPRS (musoro wekudzivirira musoro) mumwedzi ye3 kutevera, achifunga kuparadzana kwakakwana kwemashoko matatu, test 2-tailed, uye alpha yemazinga akaenzana ku0.05. Izvi zvakagadzira kukura kwemuenzaniso wevarwere ve49 neboka. Kubvumira kuti pave nehuwandu hwekuregererwa kwekodzero ye10%, takaronga kuunganidza vasikana vechi108 muchidzidzo. Ichi chiyero chekukura chakakonzera chikuru kudarika 90% simba rekuona shanduko yakawanda inoshandiswa muzvikamu zveNPRS.

 

Data Analysis

 

Zvinyorwa zvinotsanangurwa, zvinosanganisira nguva dzakawanda dzezvinyorwa zvekugadzirisa uye zviyero zvehutano hwepakati uye kupararira kwezvimwe zvinoshandiswa zvinongororwa kuti zvidimbure data. Migumisiro yehutano pamusoro wemusoro uye simba nekuremara imwe neimwe yakaongororwa ne 2-by-4 yakasanganiswa-muenzaniso yekuenzanisa kwekusiyana (ANOVA), neboka rekurapa (kushandiswa pakusangana nekusimudzira nekuita basa) sezviri pakati-zvinotenderera zvinoshandiswa uye nguva (yekutanga, 1 vhiki, masvondo e4, uye mwedzi 3 kutevera) sezvinoitwa mukati-zvidzidzo zvinoshandiswa. AOVAs akaparadzana yakaitwa neNPRS (misoro yepamusoro) uye NDII (kuremara) sechinhu chinotarisana nacho. Pamusoro peOOVA imwe neimwe, pfungwa yekufarira ndiyo nzira ye2-maitiro (boka nenguva).

 

Kuzvimiririra t-bvunzo yakashandiswa kugadzirisa pakati peboka misiyano yezana shanduko kubva muzana rekutanga kusvika pamwedzi mitatu yekutevera mune ese musoro kusimba uye kuremara. Yakaparadzaniswa Mann Whitney U bvunzo dzakaitwa neiyo frequency frequency, GRC, kutemwa kwemusoro uye kudya kwemushonga seyakavimbika musiyano. Isu takaita Little's Kupotsa Zvakakwana paRandom (MCAR) bvunzo [3] kuona kana kushaikwa kwedatha mapoinzi ane chekuita nekudonha kwaishayikwa zvisina kurongeka kana kushayikwa nezvakarongeka zvikonzero. Chinangwa-cheku-kurapa kuongororwa kwakaitwa nekushandisa Tarisiro-Kuwedzeredza uko kunoshaya data kunoverengerwa uchishandisa regression equations. Zvirongwa zviviri zvakaenzanisirwa zvakaitwa kuongorora musiyano uripo pakati pekutanga uye yekutevera-nguva pakati-pemapoka vachishandisa kururamisa kweBonferroni padanho re alpha ye .64.

 

Takaita dichotomized varwere sevanopindura pamwedzi we3 kutevera vachishandisa chikamu chakacheka chepfungwa dze 2 dzehutano hwemusoro sezvinotaridzwa neNPRS. Numeri yaidiwa kurapa (NNT) uye 95% nguva dzekutenderera (CI) dzakaverengwawo pamwedzi we3 kutevera-shandisa uchishandisa imwe yerondedzero yemugumisiro wakabudirira. Kuongorora kwedhiyabhorosi kwakaitwa uchishandisa SPSS 21.0.

 

Results

 

Makumi maviri nemakumi mashanu nemumwe varwere vane chekunyunyuta kwekutanga kwemusoro vakaongororwa kuti vakwanise kukodzera. Izvo zvikonzero zvekusakodzera zvinogona kuwanikwa muFiri. 3, iyo inoyerera dhizaini yekutsvaga murwere nekuchengetwa. Pakati pevarwere 251 vakaongororwa, varwere ve110, vane zera rinoreva makore makumi matatu neshanu (SD 35.16) uye hurefu hwezviratidzo zvemakore 11.48 (SD 4.56), vakagutsa nzira yekukodzera, vakabvuma kutora chikamu, uye vakasarudzika kuita zvisirizvo (n ? =? 6.27) nekuunganidza uye kurovedza muviri (n? =? 58) mapoka. Baseline misiyano yeboka rega rega inogona kuwanikwa muTebhu 52. Varapi gumi nevaviri vanobva kumakiriniki e1 ekurapa ekurapa mumwe nemumwe akarapwa 8, 25, 23, 20, 14, 13, 7 kana 6 varwere, zvichiteerana; uyezve, mumwe wevane gumi nevaviri varapi akarapa angangoenzana chikamu chevarwere muboka rega rega. Pakanga pasina musiyano wakakosha (p? =? 2) pakati penhamba inorehwa yekupedzisa zvikamu zvekurapa zveboka rekunyengera (12, SD 0.227) uye boka rekukurudzira uye rekurovedza muviri (7.17, SD 0.96). Uye zvakare, iyo inorehwa nhamba yezvirongwa zvekurapa izvo zvakanangana neC6.90-1.35 kutaura yaive 1 (SD 2) yeboka rekunyepedzera uye 6.41 (SD 1.63) yekusimudzira uye yekurovedza boka, uye izvi zvaive zvisina kunyanya kusiyana (p? =? 6.52). Vane zana nevanomwe vevarwere zana negumi vakapedza zvese zviyero zvemhedzisiro kuburikidza nemwedzi mitatu (2.01% yekutevera). Zvishoma Kupotsa Zvakakwana paRandom (MCAR) bvunzo yakanga isina kukosha (p? =? 0.762); Naizvozvo, isu takashandisa iyo Tarisiro-Maximization imputation hunyanzvi kutsiva akashaikwa tsika nemazita akafanotaurwa emhedzisiro yemwedzi mitatu.

 

 

 

Iboka rakazara nekudyidzana kwenguva yeiyo yekutanga mhedzisiro yemusoro wekusimba yaive yakaenzana kukosha kune iyo NPRS (F (3,106)? =? 11.196; p?

 

 

 

Pamhedzisiro yechipiri rakakosha boka nekubatana kwenguva kwaive kweiyo NDI (F (3,106)? =? 8.57; p?

 

Mann Whitney U bvunzo dzakaratidza kuti varwere vekumusoro kwechiberekero uye chepamusoro thoracic manejimendi boka vakasangana nemusoro usingawanzo kutemwa nemusoro pa1 vhiki (p?

 

Isu hatina kuunganidza chero dhata pane zvinoitika zve minor zviitiko zvakashata [48, 49] (inononoka zviratidzo zvetsinga, kuwedzera kuomarara, kupenya kwekurwadziwa, kuneta kana zvimwe); zvisinei, hapana major zviitiko zvakashata [48, 49] (kurohwa kana kusakwana kwehuropi) zvakataurwa kune chero boka.

 

hurukuro

 

Nyaya yeChinyorwa Zviwanikwa

 

Kuziva kwedu, kudzidza uku ndiko kwekutanga kurongwa kwechipatara kutarisisa kuenzanisa kushanda kwesimba remuromo wechibereko uye thoracic kukurudzira uye kurovedza muviri kune varwere vane CH. Mhedzisiro yacho inoratidza zvikamu zve6 kusvika ku8 zvekubiridzira kwemasvondo mana, zvakanangiswa zvakanyanya kune ese epamusoro emuromo wechibereko (C4-1) uye yepamusoro thoracic (T2-1) spines, zvakakonzera kuvandudzika kukuru mukusimba kwemusoro, kuremara, kutemwa nemusoro, kuwanda kwemusoro , uye kunwa mishonga pane kukurudzira pamwe chete nekurovedza muviri. Iyo poindi inofungidzira yepakati-yeboka shanduko mumusoro kusimba (2 mapoinzi) uye kuremara (2.1 mapoinzi kana 6.0%) yakapfuura iyo yakataurwa maMCID pazviyero zviviri izvi. Kunyangwe iyo MCID yeiyo NDI mune varwere vane CH isati yaferefetwa, zvinofanirwa kucherechedzwa kuti fungidziro yepasi ye12.0% CI yekuremara (95 mapoinzi) yaive zvishoma pazasi (kana kufungidzirwa muzviitiko zviviri) iyo MCID iyo yakawanikwa iine 3.5 [3.5], 65 [5], uye 66 [7.5] mapoinzi kuvarwere vane marwadzo emutsipa, 45 [8.5] mapoinzi kuvarwere vane remuromo remuromo, uye 33 [3.5] mapoinzi kuvarwere vane musanganiswa, isina-yakatarwa kurwadziwa kwemutsipa. Zvisinei, inofanira kuonekwa kuti mapoka maviri aya akaita kliniki yekuvandudza. Uye zvakare, iyo NNT inoratidza kune vese varwere vana vanobatwa nekumanikidza, pane kuunganidza, mumwe murwere anowedzera anozadzisa kiriniki yakakosha yekudzora kurwadziwa pamwedzi mitatu yekutevera.

 

Simba uye Utera hweChidzidzo

 

Kubatanidzwa kwe12 kurapa maitiro emakiriniki emunharaunda e8 mune 6 nyika dzakasiyana-siyana dzinowedzera huwandu huwandu hwekuwana kwedu. Kunyange zvazvo kusiyana kukuru kwakaratidzwa kusvika kumwedzi ye3, hazvizivikanwe kana zvikomborero izvi zvingadai zvakatsigirwa kwenguva refu. Mukuwedzera, takashandisa mashizha makuru, mashoma-amplitude manipulation techniques akashandisa bidirectional inoshandiswa pakushandura nekushandura panguva imwechete uye Maitland based grade IV PA masangano ekugadzira; saka, hatigoni kuva nechokwadi kuti izvi zvinowanzogadziriswa kune mamwe marudzi ehutano hwemapiritsi ehutano. Vamwe vangafunga kuti boka rekuenzanisira ringadai risina kuwana rubatsiro rwakakwana. Takatsvaga kuenzanisa kutarisana mukati uye kunze kwekufanirwa kwekugadziriswa kwemapoka ose uye kwakapa tsanangudzo yakajeka yehutano hunoshandiswa huchabvumirawo kudzokorora. Uyezve, isu hatina kuenzanisa zviitiko zviduku zvakashata uye takabvunzwa pamusoro pezviitiko zviviri zvinogona kukuvadza. Chimwe chiyamuro ndechekuti takabatanidza mimwe miviri yechipiri. Vaongorori vezvokurapa pamusoro pemhando ipi yavanofunga kuti yaizove yakakwirira haina kuunganidzwa uye inogona kunge inogona kukanganisa migumisiro.

 

Simba uye Kushaya Utera Mukubatana Nezvimwe Zvidzidzo: Kusiyana Kunokosha Muzviitiko

 

Jull et al. [11] akaratidza kurapwa kwehutano hwehutano hwekunyengedza uye maitiro muhutungamiri hweC; zvisinei, ichi chirongwa chekurapa chaisanganisira kusimbisa nekugadzirisa. Izvo zvidzidzo zvezvino zvinogona kupa uchapupu hwokuti kutungamira kwevarwere vane CH kunofanira kusanganisira imwe nzira yekugadzirisa pasinei nokuti inowanzotaurwa kuti chirwere chechibereki chinofanira kudziviswa nekuda kwechiitiko chezviitiko zvakakomba zvakashata [67, 68]. Uyezve, zvakaratidzwa kuti vanhu vanowana kugadzirwa kwemutsipa kwemarwadzo emutsipa uye misoro havasati vamboona chirwere chinonzi vertebrobasilar kupfuura kana vakagamuchira kurapwa nachiremba wavo wezvokurapa [69]. Uyezve, mushure mekuongorora zvakare nyaya dze 134, Puenedura et al. akagumisa kuti nekusarudzwa kwakakodzera kwevarwere nekunyatsorongedza mavara emavhogi matsvuku uye zvinopesana, huwandu hwezviitiko zvinotambudza zvinosangana nehutachiona hunogona kudzivirirwa [70].

 

Zvinoreva Zvidzidzo: Zvinogona Kunotsanangurwa uye Zvazvinoreva kune Vanachiremba nevatongi

 

Kubva pamigumisiro yezvino zvidzidzo zvechiremba vanofanirwa kufunga nezvekubatanidza kugadzirwa kwepaginal kune vanhu vane CH. Imwe nzira yekuongorora yakangobva kuwanikwa yakagadziriswa nekugadzirisa kushandiswa kwekubatsira kwevatano vane CH asi vakanga vasingakwanisi kutsanangura nzira ipi yakakosha [8]. Uyezve, makiriniki emitemo yakarondedzera kuti kushandiswa, kuunganidza uye kubhizimisa zvose zvakashanda kune vatungamiri vevarwere vane CH; zvisinei, mutungamiri haana kuita mazano pamusoro pehukuru hweimwe nzira. [71] Zvigumisiro zvemazuva ano zvinogona kubatsira vanyori vekuongororwa kwakagadziriswa nekugadziriswa kwekliniki pakupa mamwe mazano pamusoro pekushandiswa kwekupererwa kwepelinha munzvimbo ino.

 

Mibvunzo Isingagoni Kupindurwa Nekutsvaga Kwemangwana

 

Maitiro epasi ekuti nei kumanikidza kungave kwakaguma nekuvandudza kukuru kunoramba kuchitsanangurwa. Izvo zvave zvichitaurirwa kuti yakakwira-velocity kusuduruka kwe vertebrae ine simba rekusimudzira risingasviki 200 ms inogona kuchinjisa akasiyana madhivhisi mareti [72] nekumisikidza ma mechanoreceptors nema proprioceptors, nokudaro achichinja alpha motorneuron mafaro ekugwinya uye anotevera mhasuru chiitiko [72-74]. Kugadziriswa kunogona zvakare kukurudzira anogamuchira mune yakadzika paraspinal musculature, uye kukurudzira kungave kunowanzoita kuti zviite zvinogamuchirwa mumhasuru dzepamusoro [75]. Biomechanical [76, 77], musana kana segmental [78, 79] uye yepakati kudzika inodzivirira marwadzo nzira [80-83] mamodheru ndidzo tsananguro dzinonzwisisika dze hypoalgesic mhedzisiro dzinoonekwa zvichitevera mashandisiro. Munguva pfupi yapfuura, iyo biomechanical mhedzisiro yekumanikidza yave iri pasi pekuongororwa kwesainzi [84], uye zvinofungidzirwa kuti makiriniki mabhenefiti anowanikwa mukudzidza kwedu ane hukama neiyo neurophysiological mhinduro inosanganisira yenguva yekunzwa summation parunyanga runyanga rwepelinha [78]; zvisinei, uyu muenzaniso wakasarudzika parizvino unotsigirwa chete pane zvakawanikwa kubva kunonoka, kuyedza kunokonzeresa marwadzo muzvidzidzo zvine hutano [85, 86], kwete varwere vane CH. Zvidzidzo zvenguva yemberi zvinofanirwa kuongorora akasiyana emanyowa ekurapa matekiniki ane akasiyana madosi uye anosanganisira 1-gore rekutevera. Uyezve, zvidzidzo zvenguva yemberi kuongorora iyo neurophysiological mhedzisiro yekumanikidza uye kukurudzira kuchave kwakakosha kuona kuti nei pangave kana pangave nemusiyano mumakiriniki mhedzisiro pakati pemishonga iyi miviri.

 

mhedziso

 

Migumisiro yechirongwa chemazuva ano yakaratidza kuti varwere vane CH vakagamuchira kervical uye kugadziriswa kwetroracic zvakagadziriswa zvakanyanya zvikuru mukudzvinyirira musoro, kuremara, kuora musoro kwepamusoro, kushaya musoro kwepamusoro, uye kushandisa mishonga pakuenzanisa neboka rakagamuchirwa nekugadzirisa; uyezve, migumisiro yacho yakachengetwa pamwedzi we3 kutevera. Zviongorori zvenguva inotevera zvinofanira kuongorora kubudirira kwemhando dzakasiyana siyana uye maitiro ekushandiswa uye kunosanganisira nguva yakareba yekutevera.

 

KUTENDA

 

Hapana wevanyori vakagamuchira chero mari yekudzidza uku. Vanyori vanoda kuonga vose vatori vechikamu chekudzidza.

 

Mashoko Omuzasi

 

• Kukwikwidzana: Dr. James Dunning ndiye Mutungamiri weAmerican Academy of Manipulative Therapy (AAMT). AAMT inopa mapurogiramu ekurovedza mapurogiramu ekuperesa kwemusana, kugadzirwa kwemumumvuri, kuomeswa kwevasingadi, kushandiswa kwekupedzisira, kugadzirisa kwekupedzisira, kushandiswa kwechiridzwa-zvinyorwa zvinyorwa zvishoma nezvishoma uye kurapwa kwechiremba kuvarapi vezvemapirisa, maosteopaths uye vanachiremba vezvechiremba. Drs. James Dunning, Raymond Butts, Thomas Perreault, uye Firas Mourad ndivo vadzidzisi vakuru veAAMT. Vamwe vanyori vanotaura kuti havana kukwikwidzana.
• Mipiro yevanyori: JRD yakabatanidzwa mumubereki, kuumbwa, kuwanikwa kwezvinhu, nhamba yekuongorora nekunyorwa kwezvinyorwa. RB uye IY vakabatanidzwa mukugadzira, kuunganidza deta, kuongororwa kwenhamba nekudzokorora kwezvinyorwa. FM yakabatanidzwa mukugadzira, kuongororwa kwenhamba, kududzira deta nekudzokororwa kwezvinyorwa. MH akapindira mumubereki, kugadzira nekudzokorora kwezvinyorwa. CF neJC vaibatanidzwa munhamba yekuongorora, kududzira dhesi, uye kugadziriswa patsva kwezvinyorwa zvekukosha kwemagetsi. TS, JD, DB, uye TH vaibatanidzwa mukuunganidza deta uye kuvandudzwa kwezvinyorwa. Vose vanyori vanoverenga uye vanobvumirana nemashoko ekupedzisira.

 

Information Contributor

 

Ncbi.nlm.nih.gov/pmc/articles/PMC4744384/

 

Mukupedzisa,Kurwadziwa kwepamusoro kunokonzerwa nemusoro wechipiri nekuda kwenyaya yehutano pamwe chete nezvivakwa zvakapoteredzwa zvepervical spine, kana mutsipa, zvinogona kukonzera zvinorwadza uye zvinoderedza zviratidzo zvinogona kukanganisa hupenyu hwemurwere. Kugunun'una kwepamuviri uye kukurudzira kunogona kuchengetedzwa uye kunyatso shandiswa kubatsira kuvandudza cervicogenic misoro yemusoro zviratidzo. Ruzivo rwunotsanangurwa kubva kuNational Center yeBiotechnology Ruzivo (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

 

 

Zvimwe Zvinyorwa: Kubva Painini

 

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

 

NHAURWA INOKOSHA INOKOSHA: Migraine Pain Treatment

 

 

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