Fujica Single 8 P1 Manual Lymphatic Drainage

Single-8 Fujica Here is the new site for products and service: movie.project-consultant.net Super8 technology - film.project-consultant.net Mike´s cams last modification: february 10th, 2012 Single-8 a wonderful film - my favorite, but will be past The film from Fuji was made on a polyesterbase - is thinner, more flexible, more resistant against age, with less noise during projection than acetatfilms (Kodak Super8). FUJI makes some Single8 films. The format is the same as Super8 and fits also into the same projectors. Only the cartridge is different. So you need other cameras - mostly from Fujica. All Fujica´s Single8 cameras makes very good, crisp pictures with differences depending from optics.

Single 8 cameras have a filmpressureplate and makes crisp, sharp pictures which are usable for lowcost TV productions! Cardridge compartment on left side with integrated pressure plate -like DS8 or 16mm cameras Fujichrome RT25N and RT200N are daylight balanced reversal films - NO daylightfilter is required. During daylight the 25 ASA film is comparable to Kodaks old Moviechrome 40 but has finer grain! Also the 200 ASA daylight reversal film had fine grain and was good for a lot of tasks in lowlight or sports, never possible with Super8. Unknown for Super8 users: bargain soundstriping is possible by Fuji/Japan during film processing!

Lymphatic drainage massage for edema and manual lymphatic drainage. To be able to every single patient’s accurate measurements. Of lipedema p1 of 4 See. Fujica Z800 Single 8 Camera Manual. DOWNLOAD HERE. Color scan to pdf of original Fukica Z800 Single 8 Camera Manual. English only. DOWNLOAD HERE.

The worldknown extraordinary quality of FUJINON lenses and cameras is also to find in Single-8 cine cameras. FUJICA produces and sells cameras and films in Japan and Asia still today. Some few filmshops in US and Europe sells these too. Unlimited rewind/double exposure possibility + filmpressure plate for sharp pictureframes are advantages. Some cameras have variable shutter, sync connector and a lot of more. Many formerly FUJICA cameras are made for simple usage to prevent users from overcharge.

But every FUJICA had to make high quality pictures! Fujica has not followed the “unholy” trend for large zoomfactors or a lot of electronics and switches! FUJICA´s Single-8 cameras are made for usage - not for your personal image. Some cameras are very tiny: made for outdoor, party usage or for children, but with: good lenses and lowlight shutters of 220° - sometimes with manual zoom. The lightmeter of very old cameras (P1, P2, Z1 or others) works with 1.35V PX625 or 2.7V PX14 (=2xPX625) mercury cells. Newer cameras do not need this stuff.

Cameras for lowlight (220° or 230° X shutter - mostly sound cams) or with variable shutter (0-160°) are made. Fujica´s product names are often confusing. Sound cameras with similar names to silent cameras have not the same technical features and are mostly very simple. The semi- professional cameras are solid made - very good craftsmanship! The professional highend is: Fujica Z800 or the extraordinary ZC1000. With C-mountable lens. Professional FUJICA Z800 FUJICA Z800 FUJINON 1,8/8-64mm Sound: Filterthread: 62 Sync recording socket x Zoom (manual): x Others: Zoom (auto): x Wired romote control x Distance up from: 1.2 m cable release: x split screen focusing x Camera battery: 4 x 1,5V AA Exposure control: x Ext.

Charger socket: x emulsion speed set 25 until 400 ASA x Filmcounter: x Auto (lens) exposure: x weigth 1.4 kg Manual override: x Daylight/Artificial filter: Wratten 85 Frame Rates: 1, 18, 24, 36 Fade-in, Fade-out varable shutter variable shutter 40/80/120/160° lap dissolve/ overfading unlimited: rewind manual compact FUJICA Z800.in a pocket of my jacket/coat I had found surprisingly very often this tiny P300. Fine camera with 1.8/10.5-27.5 manual zoom, lowlight shutter and rewind feature.(optional crank). For surprise shootings. I have to say: I do not like seperate batteries for metering: it´s also a modified camera! Since 2007 Fuji-Film do not sell any longer their Single8 filmcartridges outside Japan. This is a bad fact, but not a real thing to put your camera into a museum. Many filmmakers and enthusiasts not only in Japan uses these fine professional cameras.

Worldwide there are companies producing there own Super8 filmcartridges with different filmmaterial from Kodak, Fuji and Fomapan. For them it should be easy to fit the same material into the (easy and cheap to produce) Single8 cartridge. In future the different processing labs worldwide will be interested to get also this Single8 market which was totally controlled by Fuji Labs in Japan. This is the reason the Single8 has good chances to be continued. [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [].

Various forms of massage, traction, and manipulation have been used in medicine throughout the world for several thousand years. Each modality represents an approach to treatment of the musculoskeletal and other systems sought by a steadily increasing number of people, despite a relative dearth of quality, evidence-based research supporting their isolated use. Research on each of these modalities continues, but they are all united by a longstanding variable, the concept of touch. In the 1940s, Spitz reported on foundling home infants who, though otherwise healthy and well taken care of, failed to thrive and often died in the absence of being held or touched. Kunz and Krieger additionally defined and taught the principles behind the related concepts of healing touch and therapeutic touch in the 1970s. Although there is no consensus on the complete physiology of massage, traction, or manipulation, it is generally accepted that there is more to these treatment approaches than just the interaction of mechanical forces and human anatomy. There is a long history of touch as a natural, essential component to healing and health maintenance.

Each of these treatments has some scientific support to back its use in certain cases or conditions, and from a logical perspective, one can assume that some middle ground exists for the application of massage, traction, or manipulation in a cautious and controlled manner within the medical paradigm. Each of these treatments also carries some risk, but given the estimates of use worldwide and the reports of direct or indirect side effects related to these therapies, the risks appear to be minimal, with the treatments offering potential benefits for patients. From an osteopathic perspective, manipulation is not intended to be a standalone treatment; rather, it is meant to be a component of the overall treatment strategy for a given patient. Indeed, current research on manipulation seems to support this use, and further research must be done on a variety of conditions to determine the best combinations to effectively and safely aid the patient’s recovery. The same concept should be applied to the investigation of massage and traction to determine how to best use these treatments in the complete care of a patient. Definition Massage is a therapeutic manipulation of the soft tissues of the body with the goal of achieving normalization of those tissues.

Massage can have mechanical, neurologic, psychological, and reflexive effects. Massage can be used to reduce pain or adhesions, promote sedation, mobilize fluids, increase muscular relaxation, and facilitate vasodilation. Massage easily can be a preliminary treatment to manipulation; however, it clearly targets the health of soft tissues, whereas manipulation largely targets joint segments. In effleurage, the practitioner's hands glide across the skin overlying the skeletal muscle being treated. Oil or powder is incorporated to reduce friction; hand-to-skin contact is maintained throughout the massage strokes. Effleurage can be superficial or deep.

Light strokes energize cutaneous receptors and act by neuroreflexive or vascular reflexive mechanisms, whereas deep stroke techniques mechanically mobilize fluids in the deeper soft-tissue structures. Deep stroking massage is performed in the direction of venous or lymphatic flow, whereas light stroking can be in any direction desired. In deep friction massage, pressure is applied with the ball of the practitioner's thumb or fingers to the patient's skin and muscle. The main effect of is to apply shear forces to underlying tissues, particularly at the interface between two tissue types (eg, dermis-fascia, fascia-muscle, or muscle-bone). Deep pressure keeps superficial tissues from shearing so that shear and force are directed at the deeper tissue surface interface.

Deep friction massage frequently is used to prevent or slow adhesions of scar tissue. The theory of shiatsu is based upon the system of the 12 traditional Chinese meridians (ie, major channels) of the body in which the energy, life force, or chi circulates. Acupressure pressure points, situated along the course of channels, allow access to these channels. Acupressure applies massage forces, largely through digital pressure, to the same points treated with acupuncture needles.

Imbalances of energy along the meridians are believed to cause disease and can be rectified by localized finger pressure. Decongestive lymphatic therapy is the complex massage approach that includes manual lymphatic drainage (MLD) in addition to compressive bandages, exercises, and skin care.

Manual lymphatic drainage consists of gentle massage in the treatment of lymphedema. Proximal areas are treated first to prevent a damming effect; the treatment is thought to stretch the lymphatic collectors and to stimulate the drainage system. The massage is followed by the application of compressive bandages and is incorporated into a complete self-care program. A prospective, nonrandomized trial of massage therapy at a major US cancer center sought to examine massage therapy outcome in a large group of patients.

Over a 3-year period, 1290 patients were treated with regular ('Swedish'), light touch, or foot massage, based on the request of the patient. The patients filled out symptom cards before and after a 20-minute (average) massage session. Symptom scores were reduced by approximately 50%, with outpatients demonstrating about 10% greater benefit than did inpatients. Anxiety, nausea, depression and pain demonstrated the greatest improvement in symptom score. Many studies have focused on the utility of massage to treat low back pain. [] The authors of one literature review concluded that strong evidence exists for the efficacy of massage in relieving chronic, nonspecific low back pain; they also found 'moderate evidence that massage provides short- and longer-term follow-up relief of symptoms.' Moreover, the authors determined there to be 'moderate evidence that acupressure may be better than Swedish massage' for chronic low back pain, 'especially if combined with exercise.'

Other effects of massage are enkephalin release, endorphin production, promotion or absorption of fibrous tissue, restoration of connective tissue pliability, improvement of lymphatic flow (in some studies, seven- to ninefold), and increased levels of natural killer (NK) cells. Tanabe et al provided animal data that suggest that mechanical stimuli, such as massage, to adipocytes may inhibit expression of adipogenic transcription factor peroxisome proliferator-activated receptor, which is independent of systemic energy consumption. Descargar Keygen Autocad Civil 3d 2015 64 Bits. [] They postulated that such stimuli can assist in reducing the body’s fat stores, and may help to decrease obesity. A 2003 review by Ernst that examined the safety of massage found that the majority of adverse effects of massage therapy came about as a consequence of performance by lay practitioners or as a result of using 'exotic' massage practices, other than Swedish-style massage. [] He further concluded that while massage therapy is not entirely risk-free, reports of serious adverse events appear to be rare. It would be beneficial for the physiatrist, or other prescribing physician, to be aware of the training and experience of the massage therapist to which he or she is referring the patient.

The amount of pressure depends upon technique and desired results. Light pressure may produce relaxation and relative sedation and may decrease spasm; breakdown of adhesions and intervention at a deeper tissue level may require heavier pressure. Treatment of edema and stretching of connective tissue generally requires intermediate amounts of pressure. Direction of massage often is centripetal to provide better mobilization of fluids toward the central circulation. The sequence of tissues treated often is performed in a centripetal fashion. The long-term efficacy of massage has not been validated.

Future inquiry must establish the long-term efficacy of massage in a more rigorous, scientific fashion. Studies are needed that use a valid experimental design and allow pretesting and posttesting; these investigations also must employ appropriate sample sizes and statistical analysis methods, include reliable and valid measurement tools, and provide some degree of standardization of duration and frequency of treatment. It is also argued that some attempt to control for the so-called placebo effect (as well as touch) must be included in future studies. Mechanical forms of traction use a hydraulic or motorized pulley system with weights, along with a harness or sling device to attach to the patient’s body. Manual traction involves the therapist using his or her hands on the patient’s body, with the body weight of the therapist providing the tractive force. Autotraction is controlled by the patient pulling on bars or handles at the head of the table, without direct involvement of a therapist.

Gravitational traction with a tilt table and underwater variations of traction are also in clinical and home use but are less frequently employed than the other forms described. Traction has enjoyed a long history of clinical acceptance based upon very little scientific understanding of its mechanism of action or efficacy. Two 2005 surveys examined the use of traction by physical therapists. One, by Haarte et al, [] contained data from the United Kingdom, whereas the second, by Poitras et al, [] was performed in Quebec, Canada. Both surveys reported widespread use of traction by physical therapists for the treatment of low back pain. Significant questions exist regarding duration of symptom relief and other benefits derived. Given the difficulty of objective documentation of the benefits of traction, it is not surprising that there has been a reduction in its use.

Indications The literature does not clearly indicate which types of neck or low back pain may improve from traction. Studies strongly suggest that traction has no significant influence on the long-term outcome of neck pain or low back pain.

Practitioners who rely on sound scientific advice may use traction rarely. Practitioners who are receptive to empiric treatments may be amenable to the concept that traction may separate vertebrae and decrease the size of herniated disks, thereby benefiting radiculopathy; however, no consensus has been reached among clinicians or researchers in this area. In a 2008 review investigating the use of lumbar traction for patients with chronic low back pain, Gay et al found only 10 randomized, controlled trials addressing this treatment.

[] As a group, the studies contained more evidence against the use of traction than for it. The authors broke the information into subcategories on the basis of whether the data covered patients with back and lower limb pain or patients with low back pain alone. They also looked at sustained and intermittent traction in these patient groups. The results indicated a lack of benefit in the use of sustained traction for chronic low back pain, with or without lower limb symptoms.

[] Motorized, intermittent traction, which has been aggressively marketed (eg, VAX-D, DRX9000), likewise did not seem to differ in efficacy from simple intermittent axial traction. Gay et al cautioned against fully extrapolating the results of the available randomized, controlled trials to the distraction-manipulation therapies at present, until further research can be completed specifically assessing their effects. Research on this approach is ongoing.

Akbino et al monitored systolic and diastolic blood pressure, heart rate, rate pressure product, and electrocardiography (ECG) at 5-, 10-, and 15-minute intervals during administration of cervical traction at 7.5%, 10%, or 15% of the patient’s total body weight (TBW). [] In comparison with premeasured baseline values, decreases were noted in systolic blood pressure, diastolic blood pressure, and rate pressure product for all subjects in all three groups. Although the change was not statistically significant in the 7.5% group, it was for the 10% and 15% groups. There was no significant difference in heart rate or ECG variables in any group. A study from Hungary reanalyzed an old method of applying traction in the treatment of patients with lumbar or cervical diskopathy. [] Patients were vertically suspended by a special harness in a warm-water bath, with a specified amount of weight applied to the lower limbs. One harness allowed for traction on the lumbar spine, while the other focused on the cervical region.

The study participants had land-based physical therapy exercises and the weight-bath therapy, while a control group only had the exercises. In this study, therapeutic benefit was perceived to be greater by patients treated with a combination of the weight-bath and exercise than it was by patients in the control group, according to results following treatment and at 3-month follow-up.

The treatments were well tolerated, and no adverse effects were reported. Although the study concluded that this form of traction treatment 'is a relatively straightforward, non-invasive, and low-cost intervention that can be implemented anywhere,' further research may be needed to corroborate the findings of this pilot study. Such investigation may need to be supplemented with cost and feasibility data before widespread implementation is initiated. Studies have shown that, in the cervical spine, larger improvement in range of motion (ROM) with less accompanying pain was noted in patients subjected to intermittent traction of 20 lb peak (10 seconds on, 10 seconds off, for a total of 15 minutes of treatment time) than in patients subjected to 15 minutes of manual or static traction of 25 lb.

Constant cervical distraction forces of 30 lb generate maximum vertebral separation in 7 seconds or less, and no further separation is gained by applications of up to 60 seconds. Studies, in addition to patient preference, suggest that some relative advantage exists to an intermittent versus continuous protocol of cervical traction. Some studies report that continuous traction is necessary in the lumbar spine to fatigue muscles and allow strain to fall on joints; however, no statistical difference has been observed with either continuous traction of 100 lb for 5 minutes or intermittent traction of 100 lb, peaking for 15 minutes. As in traction on the cervical spine, improved patient tolerance favors an intermittent protocol. In the sitting position, application of approximately 10 lb is required to counterbalance the patient's head in cervical traction. Traction of 30 lb applied to a neck flexed up to 24° can cause vertebral separation, but an increase of force to 50 lb has been found to produce no clear-cut additional separation.

In the lumbar spine, a pull, which equals approximately 50% of the weight of the body part, is needed to overcome friction. As noted for the lower body, this amounts to approximately 26% of total body weight. Duration of therapy The optimal duration of traction has not been clearly defined. Recommendations have ranged from 2 minutes to 24 hours in the cervical spine. A duration of approximately 15-25 minutes is commonly prescribed.

Cervical traction generally is prescribed at a frequency of daily for the first week and then every other day (ie, three times per week) for a total treatment duration of approximately 3-4 weeks. In the lumbar spine, treatment generally is recommended in the 8- to 40-minute range per session, daily for the first week and then every other day (ie, three times per week) for a total of 3-4 weeks. A systematic literature review by Clarke et al further supported the aforementioned conclusions regarding traction for low back pain.

[] Through an examination of randomized clinical trials, the authors determined that the evidence did not support the intermittent or continuous use of traction alone to treat low back pain in mixed groups of patients suffering from this condition, whether or not sciatica was present. Owing to inconsistent results and methodologic problems in most of the studies involved, the authors also did not recommend traction for patients with sciatica. They also stated that because the available research was insufficient, they could not comment on the use of traction in combination with other therapies. A 2013 Cochrane review of 32 randomized, controlled trials involving 2762 participants who had low back pain with or without sciatica concluded that traction, whether used by itself or in conjunction with other therapies, exerted little or no effect on pain intensity, functional status, global improvement, and return to work in these patients. [] The authors noted that the quality of the evidence was limited and stated that the use of traction to treat nonspecific low back pain could not be motivated by the best available evidence.

Studies that claim improvement after traction report modest and very short-term improvements, with limited or no improvement in overall function. Additionally, these studies have significant design flaws. Although a particular group of patients may benefit from a particular type of traction for either short-term or long-term improvement in functional outcome, the literature currently does not identify this patient population. In addition, it is important to note that whereas high-quality evidence supporting the use of traction for the treatment of low back pain is currently scarce, the available data in the literature are also insufficient to show that traction is not effective for this problem.

Cervical traction Few randomized, controlled trials address patient outcomes after cervical traction. Whereas many studies have produced statistically significant findings, the actual clinical significance of those findings is not clear. Some studies have been published on new protocols for cervical traction, as well as on new devices for traction application. Additional evidence for the efficacy of these devices and methods appears to be needed before widespread application can be made or recommended. The past few decades have seen a rapid growth in manipulation and manual therapy and an increase in its public use. Some healthcare professionals' opposition to the use of manipulation is explained by the fact that manipulation requires skills significantly different than those acquired in allopathic medical schools. This difference separates practitioners who possess manipulation skills from those who do not.

The techniques used in manipulation also fall outside of the mainstream of allopathic medicine. Referral to another physician practitioner often works well, but potential problems exist, especially regarding patient referral.

This issue may be addressed through a specific referral that states the exact nature and scope of the evaluation and treatment requested, that encourages discussion with the referring physician, and that makes clear the intention of the physiatrist to resume the remainder of the patient's care. If the referral is to a licensed nonphysician practitioner, first diagnose the appropriate problem and write a specific prescription for manipulation. Postdoctoral training programs, such as those approved or offered by the American Academy of Physical Medicine and Rehabilitation, the American Association of Colleges of Osteopathic Medicine, and other organizations, may provide a means by which the physiatrist can become acquainted with the skills necessary to begin manipulative care. Interest among physiatric residents in acquiring manipulative skills is high, and this fact has expanded training opportunities for physicians. Many residency programs now include required and/or optional training in manipulative skills.

Patient selection The physiatrist usually is able to identify, through focused musculoskeletal examination, patients who are most likely to benefit from manipulative care. Although some manipulation techniques have applicability to hospitalized patients, most persons for whom manipulation is considered appropriate are encountered in the outpatient setting. This constituency includes patients with structural problems (eg, vertebral rotations, pelvic asymmetries, sacral torsions, other entities in which diagnosis relies on palpatory skill).

On one hand, one can elect to treat in the direction of restriction, or into what is commonly called the 'ease of motion'—that is, away from the restricted motion. A direct technique engages the motion barrier; this means that the practitioner directs forces into and through the motion barrier. On the other hand, an indirect technique allows the body’s inherent neurologic or intrinsic forces to release the restriction, as the practitioner positions the area to be treated opposite the direction of a restriction. The practitioner rotates, side-bends, and either flexes or extends the adjacent vertebral segments, locking the facet so that further motion is limited to the segment in question. The vertebral segment is then moved passively to its limit of motion (or barrier) in order to remove slack motion, and a small force, localized to the specifically identified joint, is applied to hold that position. Brief, controlled thrust is applied in the direction perceived as limited, and a small motion in the desired direction occurs as the vertebra crosses its barrier. Forces, duration of actions, acceleration, and displacement values for direct-thrust techniques have been measured.

These forces peak in the range of 100-400 N over a period of approximately 150 ms. Direct manipulative techniques featuring forces applied over transverse or spinous processes are short-lever techniques. If force is applied distant to the vertebrae through the locked column, the procedure is considered a long-lever technique. All direct-thrust techniques must have forces well localized and specifically directed, and structural diagnosis must be adequate before their application. Articulatory technique Articulatory technique (low velocity/high amplitude) involves passive movement of a vertebral joint within reduced range of motion (ROM), defined by its resting position and dysfunctional limitation of motion. Extent of motion at its end point may vary, but the ultimate end point and dysfunctional barrier become the same, with the barrier becoming attenuated with repeated motion.

The quality or feel of induced motion, in addition to the quantity of force and excursion, are normalized by this procedure. A small amount of additional force occasionally may take the vertebra through its barrier or restriction. Indirect positional techniques Indirect positional techniques (eg, counterstrain and functional techniques) are based on the underlying principle that somatic dysfunction or hypomobility is caused by an inappropriately firing muscle group rather than by shortened, passive tissue (eg, joint capsule, ligament, or fascia). Thrust, articulation, and muscle energy techniques employ forces that could be expected to lengthen shortened, passive tissues, whereas these positional techniques change an inappropriate engram of muscle behavior.

Functional techniques, like counterstrain, have a methodologic approach oriented to resetting inappropriate afferent impulses from nociceptors and mechanoreceptors, resulting in efferent alpha motor activity to the skeletal muscle, by placing the joint or body part into a position of maximum ease. In contrast to counterstrain, however, the position is found and monitored by the practitioner, who senses either increased resistance to trials of small, induced motions or increased tissue tension of the nearby tissue when motion is induced. The most relaxed position is held in this balanced state. The physician positions the patient and removes slack as in direct thrust procedures and subsequently prevents active motion of the affected vertebral segment away from its barrier.

The patient then exerts minimal to moderate isometric force against resistance offered by the physician for approximately 5-10 seconds and subsequently relaxes. The physician then finds that the barrier has been displaced and that the affected segment moves beyond its original barrier. This procedure is repeated two or three times, with diminishing gains and increased ROM.

Myofascial release Myofascial release techniques are directed at vertebral, segmental, or generalized hypomobility. Myofascial release can be indirect (ie, when a restricted area is placed into a position of little resistance until subsequent relaxation occurs) or direct (ie, when the affected area is placed against a restrictive barrier with constant force until fascial release occurs).

All the myofascia of the body are interconnected, and when one area is tight or restricted, diminished movement occurs not only locally but (potentially) in distant, related areas. Craniosacral manipulation Craniosacral manipulation is based on the concept of a primary respiratory mechanism (ie, a cyclic, palpable, rhythmic wave of inherent motion appreciated most easily in the cranial and sacral areas). This wave may represent a continuous state of flux in the cerebrospinal fluid (CSF). This primary mechanism may entail inherent mobility of the central nervous system (CNS), CSF fluctuation, cranial bone articular mobility, involuntary motion between the sacrum and ilia, and mobility of interspinal and intercranial membranes. Duration of therapy Direct techniques (eg, high-velocity/low-amplitude thrust) usually have immediate effect, and improvement is seen within 1 week. Indirect techniques may take longer for the effect to be seen.

Caution must be used to avoid unnecessary continuation of treatment when pain relief does not correlate with biomechanical improvement. If the patient's condition does not improve objectively within 2-4 weeks, reevaluation of the structural diagnosis, manipulative approach, or other therapeutic plan is indicated. Determine the duration of each course of therapy on a case-by-case basis. Manipulative care has been shown to decrease use of medication and physical therapy, to be superior to conventional treatment and placebo manual care, and to be most efficacious in persons with noncomplicated acute low back pain. [] It results in less disability and faster recovery, as well as in greater improvement in pain and activity tolerance, and is a valuable adjunct to an ongoing exercise program.

It has been shown to be useful in the treatment of upper, middle, and perirespiratory infections, as well as advanced cardiopulmonary disease, headache, and neck pain. Complications of manipulation generally arise because of poorly skilled/trained practitioners or result from the performance of contraindicated procedures. No documented or anecdotal reports of complications resulting from articular, isometric, counterstrain, functional, soft-tissue, or myofascial release techniques exist. Most reported complications involve direct-thrust (high velocity/low amplitude) techniques that generally have been done in the cervical region, and in almost all cases, the neck was extended inappropriately during the procedure. Manipulation, specifically its application to the cervical spine, has been mentioned in the lay press.

Associations have been made between cervical high-velocity thrust techniques and vertebrobasilar artery and strokelike symptoms. Given the number of such manipulative treatments performed in the United States and Canada alone on an annual basis (estimated conservatively in the tens of millions) and the number of reported cases of such events per year (estimated to be in the single digits), cervical spinal manipulation is a relatively safe procedure. Nevertheless, a thorough physical examination, including a neurologic examination and an assessment of the patient’s comorbid conditions and risk factors, must be conducted before such manipulation is performed. If a thrusting technique is chosen, the force used should be the minimum necessary to achieve the correction and should be localized as precisely as possible to the restricted segment. Extremes of motion in any direction, but especially cervical extension, should be avoided because these end ranges are the ones most often associated with poor treatment outcomes. A 2015 Cochrane review evaluated 51 trials involving 2920 participants with acute, subacute, or chronic neck pain to assess the effects of manipulation or mobilization alone against those of an inactive control or another active treatment with respect to various outcome measures.

[] Manipulation and mobilization yielded similar results for every outcome at immediate, short-term, and intermediate-term follow-up. Multiple cervical manipulation sessions appeared to provide better pain relief and functional improvement than certain medications at follow-up. A systematic review of manipulation-associated adverse events in children, which included information culled from many case reports, found that such events invariably involved children younger than 13 years and typicallym appeared to be associated with diagnoses not commonly addressed by manipulation. [] The authors performed literature searches using multiple electronic databases for articles published from 1900 to 2005. Given the large number of patients treated with spinal manipulation during this time period, they felt it reasonable to conclude that 'adverse events resulting from spinal manipulation are either remarkably rare or underreported.'

Manipulation is a mechanical intervention. Hypotheses that explain somatic dysfunction usually involve position and treatment of vertebral bodies, muscle, fascial segments, or other body parts, as well as soft tissue. Acute pathologies (eg, fractures, ligamentous tears, tumors, avulsions, joint inflammation) are not considered amenable to manipulation as a primary mode of treatment. Some pattern of neuromuscular behavior resulting in early localization of hypomobility may respond to manipulative care. Thrust and, possibly, articulatory and isometric techniques stimulate Golgi tendon organ input. Articulatory and isometric techniques may elicit permanent lengthening of collagenous tissue by inducing a permanent set with repeated stretching. Direct-thrust techniques result in high stress levels and probably in high strain levels in soft tissues over a short period of time.

Nonuniform distribution of strain may develop, leading to localized tissue injury and subsequent healing with permanent elongation, with the net result being that vertebrae regain normal motion play; the forces needed to produce motion then are normalized. Subsequent literature reviews examining the use of manipulation in treating pain in the cervical and lumbar regions also supported its use.

Eureka Seven Complete Best Rar there. Bronfort et al found moderate evidence to support the use of spinal manipulation and mobilization in the treatment of chronic low back pain, stating that such treatment is 'at least as effective as other efficacious and commonly used interventions.' [] Li et al concluded that when combined with exercise, soft-tissue manipulation for lumbar muscle strain is more significant. Research relating to manipulation Numerous clinical trials of spinal manipulative treatment have been summarized in the literature. Further, manipulative treatment has been the subject of multiple international consensus meetings. Trials have attempted to improve knowledge by comparing thrust with nonthrust (ie, direct with indirect) techniques and joint-specific with non-joint-specific manual therapies, by varying the frequency and intensity of interventions and by comparing different types of joint-specific manipulation techniques.

Anatomy and physics of manipulation Understanding of the biomechanics of direct-thrust manipulation has significantly advanced. Indirect (ie, nonthrust) manipulation has been studied less. The external mechanical forces involved, the duration of the application of those forces, and the gross anterior/posterior displacements have been measured in human subjects, and relative displacements have been measured in cadaver studies. Study of internal forces and relative displacements of vertebral bodies resulting from applied forces has not been performed. Author J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR Senior Associate Dean, Associate Dean of Clinical Medicine, Consultant in Sports Medicine, Assistant Vice President of Program Development, Division of Health Sciences, DeBusk College of Osteopathic Medicine; Professor of Physical Medicine and Rehabilitation, Professor of Osteopathic Manipulative Medicine, Lincoln Memorial University-DeBusk College of Osteopathic Medicine J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR is a member of the following medical societies:,, Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. For: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital Patrick M Foye, MD is a member of the following medical societies:, Disclosure: Nothing to disclose.