Thesis (Ph. D.)--University of Washington, 2005. / Vita. Includes bibliographical references (leaves 101-107).

Orientador: Francisco Haiter Neto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-14T23:56:05Z (GMT). No. of bitstreams: 1 Caldas_MariadePaula_D.pdf: 2507510 bytes, checksum: e7cf9f14f77a9d0d37e99a3d58f6aa74 (MD5) Previous issue date: 2009 / Resumo: O objetivo neste trabalho foi avaliar a aplicabilidade do método de análise da idade óssea vertebral, proposto por Caldas et al. (2007) nas diferentes regiões do país. Para isso, foram utilizadas radiografias cefalométricas laterais e radiografias carpais de 381 meninas e 336 meninos, com faixa etária variando entre 7 e 15.9 anos, pertencentes a arquivos digitais de seis clínicas de Radiologia Odontológica provenientes das cidades de Belém-PA, Fortaleza-CE, Recife-PE, Brasília-DF e Curitiba-PR. Nas radiografias cefalométricas laterais, os corpos das vértebras C3 e C4 foram medidos com o auxílio de uma análise computadorizada das vértebras cervicais inserida no programa de cefalometria digital Radiocef Studio 2 e as idades ósseas das vértebras cervicais foram automaticamente calculadas, utilizando as equações de regressão desenvolvidas por Caldas et al. (2007). Nas radiografias carpais, os eventos de ossificação da mão e do punho foram avaliados e as idades ósseas determinadas pelo método de Tanner e Whitehouse (TW3). Os dados foram encaminhados à análise estatística de variância e teste de Tukey (p<0,05) para comparar idade óssea vertebral, idade óssea carpal e idade cronológica. Os resultados obtidos revelaram que, em todas as regiões estudadas, a idade óssea vertebral não apresentou diferença estatística significante em relação à idade cronológica. Quando analisada a relação entre as idades ósseas, foi possível observar diferença estatística significante entre idade óssea vertebral e idade óssea carpal nos sexos masculino e feminino das regiões Norte e Nordeste, assim como no sexo masculino da região Centro-Oeste. No entanto, as diferenças não foram maiores que 0,61, 0,31 e 0,45 anos para as regiões Norte, Nordeste e Centro-Oeste, respectivamente.Com exceção do sexo masculino na região Norte e do sexo feminino na região Nordeste, não foi encontrada diferença estatística significante entre idade óssea e idade cronológica. Para as regiões Norte e Nordeste, as diferenças encontradas foram de 0,44 e 0,26 anos para o sexo masculino e feminino, respectivamente. Baseados nestes resultados, pôde-se concluir que as fórmulas desenvolvidas por Caldas et al. (2007), para avaliação objetiva da idade óssea pelas vértebras cervicais, se mostraram confiáveis e podem ser utilizadas na população estudada. / Abstract: The aim of this study was to evaluate the applicability of the formula developed by Caldas et al. (2007) in Brazilian subjects. The samples were taken from patient digital files of six Oral Radiological Clinics placed in Belém-PA, Fortaleza-CE, Recife-PE, Brasília-DF e Curitiba-PR. Lateral cephalometric and hand-wrist radiographs of 381 girls and 336 boys (aged 7.0 to 15.9 years) were selected. On the digital lateral cephalograms, the bodies C3 e C4 were measured using a cervical vertebral computerized analysis created in the software program of digital cephalometric analysis Radiocef Studio 2 and cervical vertebral bone age was calculated using the formulas developed by Caldas et al. (2007). Hand-wrist bone age was evaluated by the Tanner and Whitehouse method (TW3). An analysis of variance (ANOVA) and Tukey test were used to compare cervical vertebral bone age, hand-wrist bone age and chronological age (P <0.05). No significant difference was found between cervical vertebral bone age and chronological age in all regions studied. When analyzing bone age, it was possible to observe a statistically significant difference between cervical vertebral bone age and hand-wrist bone age for female and male subjects in the North and Northeast regions, as well as for male subjects in the Central West region, which were no more than 0,61, 0,31 e 0,45 years in the North, Northeast and Central West regions, respectively. No significant difference was observed between bone age and chronological age in all regions except for the male subjects in the North and female subjects in the Northeast, which were 0,44 and 0,26 years, respectively. We concluded that the formulas developed by Caldas et al. (2007) to objectively evaluate skeletal maturation are reliable and can be applied to Brazilian subjects. / Doutorado / Radiologia Odontologica / Doutor em Radiologia Odontológica

M.Tech. (Chiropractic) / Purpose: This study aims to ascertain the extent Chiropractic manipulative therapy increases ROM beyond the joint-separation induced ROM initially experienced via the cavitation phenomenon in the absence of neck pain. Method: Sixty participants between eighteen and thirty-five years of age, thirty male and thirty female whom met the inclusion of no neck pain and perceived decreased ROM were selected for participation. There was a single group with each participant‟s pre-adjustment readings acting as a baseline. Procedure: Participants were assessed for hypomobility and joint dysfunction. Those who met the inclusion criteria underwent a detailed history, physical and cervical spine regional examination on the initial consult. A pre-adjustment objective measurement was acquired using a cervical spine range of motion (CROM) device. Once the consent form was signed participants received Chiropractic cervical spine manipulative therapy to the area/s of the cervical spine found to be restricted on motion palpation by the researcher. Post-adjustment objective measurements were taken at one, twenty, forty and sixty minutes using the CROM device. Participants were required to remain in the researcher‟s examination room for 60 minutes post-adjustment with continuation of regular day to day activity and no strenuous activity during the twenty-four hour period of the study. The participant was required to return for a single follow up visit within a time frame of twenty-four hours of the initial visit. The follow-up visit required no treatment. At twenty-four hours, the participant was objectively measured for cervical spine ROM using the CROM. The results were based on objective data in the form of cervical spine ROM measurements. Results: Clinical analysis of the percentage change in cervical spine ROM values revealed that clinically and statistically significant improvement was seen in all ranges of motion post-adjustment. General consensus showed that a peak value of improved ROM was seen post-adjustment at the one minute interval for all ranges of motion except flexion. Flexion demonstrated a peak ROM value at the twenty minute post-adjustment interval.

M.Tech. / Purpose: Acupuncture has been a controversial issue in the medical world for many years before the sceptic western medicine slowly adopted its idea. Some mechanisms for pain relief were clinically researched and proven to be valid as well as effective in treating tension-type headaches (Stux, Berman and Pomerantz, 2003) The purpose of this study was to assess and compare the effects of cervical spine manipulation and needling of acupuncture points in those patients with tension-type headache and suggest another complimentary treatment to the chiropractic manipulation, especially in those patients where manipulation is contraindicated to manipulation. If found to be effective, various mechanisms have been suggested in the formation of tension headache episodes. Those mechanisms may be alterations within the spinal cord and/or brainstem gating mechanisms as a result of facet joint dysfunction, sensitization of nociceptors in the peripheral structures of the body and psychological factors. Method: This study consisted of two groups, consisting of 16 subjects in each group. All participants were screened for tension-type headaches and accepted based on the inclusion and exclusion criteria. The subjects were between the ages of eighteen and thirty-five. Group 1 received chiropractic manipulation treatment to the most restricted levels in their cervical spine. Group 2 received treatment consisting of needling of acupuncture points to specific predetermined points. Procedure: Each successful candidate was treated six times over a 3 week period which included a total of seven sessions. Before the beginning of the treatment, the successful candidate completed the Vernon-Mior Neck Pain and Disability Index Questionnaire and the Numerical Pain Rating Scale. Readings for cervical spine ranges of motion were then taken with a CROM device. In group 1, chiropractic manipulation was then delivered to the most restricted segments in the cervical spine. In group 2, needling of six predetermined acupuncture points for relieving tension-type headache was performed bilaterally. The same treatment procedure was administered at sessions one through six, the CROM readings and questionnaires were taken in sessions one, three, five and seven. Results: The results were obtained by using the Mann-Whitney U and t-test. No statistically significant differences were identified between the groups, when comparing the 2 treatment methods at the visits. However, both groups showed a statistically significant improvement over time within each group individually for subjective measurements and for right lateral flexion in the objective measurements. Conclusion: The results were inconclusive with regards to the prolonged effects of chiropractic manipulation and needling of acupuncture points on cervical spine range of motion in patients with tension-type headache. However, it was concluded that both methods of treatment had beneficial effects on how the participants perceived their pain and disability. Due to the small group of subjects and relatively short duration of the study, accurate conclusions could not be formulated. The findings obtained were insignificant and further research needs to be performed on the effects of cervical spine manipulation and needling of acupuncture points on those suffering with tension-type headache.

M.Tech. / Purpose: Heachaches are a very common complaint among society today, and as a result there are a vast number of individuals seeking medical treatment specifically for headaches (Alix and Bates, 1999). The impact that headaches have on a patients quality of life far exceeds that of other conditions such as osteoarthritis and hypertension. Primary headaches such as Cervicogenic, Cluster and Tension-type headaches have no specific underlying cause. However, it has been shown that spinal manipulative therapy (SMT) can be used as an effective tool in the treatment of these primary headaches (Brontford, Assendelft, Evans, Haas, and Bouter, 2001; Khoury, 2000 and Vernon, 1995). A Cervicogenic Headache is defined by the North American Cervicogenic Society (NACHS) as referred pain perceived in any region of the head caused by a primary nociceptive source in the musculoskeletal tissues innervated by cervical nerves. The aim of this study was to determine the efficacy of upper cervical spine manipulation in conjunction with Interferential current and Ultrasound therapy, compared to upper cervical spine manipulations alone as a treatment protocol for Cervicogenic headaches. Method: This study consisted of two groups; both Group 1 and Group 2 consisted of 15 participants with Cervicogenic headaches. The participants were between the ages of 18 and 55 years. Potential participants were examined and accepted based on the inclusion and exclusion criteria. Group 1 received spinal manipulative therapy over restricted segments in the upper cervical spine C1-C3 levels. Group 2 received a combination treatment with Interferential current and Ultrasound therapy over active myofascial trigger points in the Posterior Cervical muscles in conjunction with spinal manipulative therapy over restricted segments in the upper cervical spine C1-C3 levels. Objective and subjective findings were based on the treatments. Procedure: The participants received six treatments in total over a three week period that is two treatments a week for three weeks followed by a seventh consultation visit where only subjective and objective measurements was taken. The participants completed a Numerical Pain Rating Scale and Headache Disability Index Questionnaire. Algometer readings were taken over the most sensitive trigger point in the Posterior Cervical muscles. Group 1 received spinal manipulative therapy over restricted segments in the upper cervical spine and Group 2 received a ten minute combination treatment with Interferential current and Ultrasound therapy over active myofascial trigger points in the Posterior Cervical muscles in conjunction with spinal manipulative therapy over restricted segments in the upper cervical spine. The same treatment procedures were administered over the study; subjective and objective readings were only taken at visits 1, 4 and 7. Results: In terms of objective measurements based on the pressure Algometer readings, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. No statistically significant difference in muscle sensitivity between the two groups over time was revealed. However, Group 1 showed a larger overall clinically significant difference in Posterior Cervical muscle sensitivity. In terms of subjective measurements based on the Headache Disability Index Questionnaire scores, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. No statistically significant difference in terms of intensity, duration and frequency of the headaches between the groups over time was revealed. However, Group 1 had a greater clinical reduction in intensity, duration and frequency of headaches when compared to Group 2. In terms of subjective measurements based on the Numerical Pain Rating Scale scores, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. A statistically significant difference in terms of intensity of the headaches between the groups over time was revealed. The overall clinical improvement was similar for both groups however Group 1 had a slightly greater clinical reduction in headache intensity when compared to Group 1. Conclusion: Both groups showed an overall improvement in the headache symptoms as well as Posterior Cervical muscle sensitivity; however Group 1 showed a greater clinical improvement when compared to Group 2.

M.Tech. (Chiropractic) / The purpose of this study was to compare the immediate effect of upper versus lower cervical manipulation on the vertebral artery blood flow in asymptomatic individuals. Thirty patients of both genders between the ages of 18-45 years of age, volunteered to participate in this study. Each participant presented with at least one upper and one lower rotary cervical facet restriction. Each participant was randomly placed into either Group 1 whom received upper cervical manipulation, or Group 2 whom received lower cervical manipulation. Any participants who presented with positive VBAI signs or symptoms were excluded from this study. The Medison SonoAce 8000 Ultrasound System was used to objectively measure the blood flow as close to C1-C2 region as possible, contralateral to the side of the adjustment contact. Three measurements were recorded in total which included neutral, pre-manipulation and post-manipulation. As this study included asymptomatic participants, no subjective data was collected. Statistical analysis was performed where the intragroup analysis was done using the Paired Sample t-test and inter-group analysis was done using the Independent Samples t-test to check for statistically significant results less than the p-value of 0.05. There were no statistically significant results found in Group 1 and Group 2 in isolation in the intragroup analysis as well as when compared in the intergroup analysis. Upper cervical manipulation resulted in a slight percentage increase in mean blood flow velocity. Lower cervical manipulation resulted in a decreased end diastolic blood flow velocity after manipulation which indicated the possibility of vertebrobasilar occlusion, however, it did not result in much change with regards to mean blood flow velocity. In addition, upper as well as lower cervical v manipulation had a minimally insignificant dilating effect on the diameter of the upper vertebral artery which may have been due to reflex vasodilation. This study demonstrated no statistically significant changes in isolation in the intragroup analysis as well as when compared in the intergroup analysis. Lower cervical manipulation did however have a moderate influence on the upper vertebral artery blood flow but overall was still less stressful in comparison to upper cervical manipulation. Additional studies are suggested to clarify these findings further.

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg 2017. / Neck pain is one of the most common debilitating musculoskeletal complaints seen in physiotherapy practice. It is often associated with headache, upper back and shoulder/arm pain (cervico-brachial pain) and such patients are more disabled than patients with neck pain only. Cervico-brachial pain syndrome is an upper quarter pain syndrome in which neural tissue sensitivity to mechanical stimulus is thought to play a role. Neuropathic pain is a problem associated with and prevalent in neck and arm pain. Psychosocial factors, such as fear-avoidance beliefs and catastrophising, have been shown to play an important role in treatment outcomes. Neural mobilisation (NM) is often used to influence the neural structures in conditions with signs of neural involvement or neural mechano-sensitivity. It seems reasonable to use neural mobilisation in cervico-brachial pain as neural structures play an important role in this condition The optimal treatment intervention for cervico-brachial pain is yet to be established. The prevalence of cervico-brachial pain in a South African population is also unknown. Aims of the study The aims of the study were to: i. To establish the prevalence of cervico-brachial pain in patients being seen in physiotherapy practices in Pretoria, South Africa. ii. To establish the effect of neural mobilisation on the pain, function and quality of life of patients with acute and sub-acute cervico-brachial pain. iii. To establish the influence of high catastrophising scores and neuropathic pain on treatment outcomes. iv. To establish the effect of demographic factors on the pain, function and quality of life of patients with cervico-brachial pain. Methods Research Question 1. A retrospective survey of physiotherapy patient records dated 1 January 2011 to 31 December 2011 was conducted. The prevalence of patients with neck pain in relation to other musculoskeletal complaints was calculated and expressed as a percentage. Symptoms recorded included the following; headache, dizziness, pins and needles, feeling of weakness, other sensations, more than one symptom and pain in other area/s. Based on body charts, areas of pain were coded as neck pain only, pain in the shoulder, shoulder and upper arm, shoulder to elbow, lower arm, hand, neck and arm up to wrist, neck and arm including hand. Research Questions 2, 3 and 4 A single blind randomised clinical trial was conducted to establish the effect of neural mobilisation on cervico-brachial pain. The intervention group (IG) received cervical and thoracic mobilisation exercises, advice and NM. The usual care (UC) had the same treatment without NM. Outcomes were assessed at 3 weeks, 6 weeks, 6 months and 12 months. The Numerical Pain Rating Scale was used to determine the effect of NM on pain. The Patient Specific Functional Scale was used to determine the effect of NM on function and the EuroQual5 instrument was used to establish the effect of NM on the quality of life. At 6 weeks the Global Rating of Change was administered to measure patient’s perception of recovery. The Neuropathic Diagnostic Questionnaire (DN4) was used to classify patients with neuropathic pain and the Pain Catastrophising Scale to identify catastrophisers. Results and Discussion Prevalence of neck and radiating arm pain in physiotherapy private practice, Pretoria South Africa The prevalence of neck pain in private physiotherapy practices in Pretoria, SA is high (46.4% of the total musculoskeletal complaints) with radiating arm pain (52.2% of neck pain population) and pain in other areas (22.6% of neck pain population) being commonly associated with neck pain. Furthermore, other symptoms such as headache (25.4% of the neck pain population) and paraesthesia (11.2%) are also frequently present. Neck pain is multi-faceted and this has implications for its management. Future studies with a bigger, representative population sample are needed to establish the prevalence of neck pain in SA. The effect of neural mobilisation on cervico-brachial pain All patients improved significantly in terms of pain, function and quality of life over the 12-month period. However, the IG had significantly less pain than the UC group at 6 months (p=0.03 95% CI 0.96 - 2.03) and this difference was more pronounced in patients with neuropathic pain (IG 2.91 95%CI 1.74 - 4.08 and CG 5.5 95% CI 3.45 - 7.55 p=0.01). There were no significant differences between groups in terms of function or quality of life. Patients with neuropathic pain had significantly more pain at 6 months (positive neuropathic pain 3.71 95%CI 2.57 – 4.84; negative neuropathic pain 1.44 95% CI 0.93 – 1.96 p=0.0001) and 12 months (positive neuropathic pain 3.23 95% CI 1.74 – 4.71; negative neuropathic pain 1.38 95% CI 0.88 – 1.91 p=0.01) compared to those without neuropathic pain. At 12 months function was also negatively affected by the presence of neuropathic pain (positive neuropathic pain 23.91 95%CI 20.96 – 26.86; negative neuropathic pain 27.15 95% CI 25.95 – 28.36 p=0.04). It did not have an effect on quality of life. Catastrophisers had more pain at 6 months (catastrophisers 4.25 95% CI -1.90 – 10.40; non-catastrophisers 1.70 95% CI 1.22 – 2.17 p=0.02) and 12 months (catastrophisers 3.56 95% CI 1.10 – 6.02) compared to non-catastrophisers (1.47 95% CI 0.96 – 1.99 p=0.02). There was no difference in their function at any time, however at baseline they reported a lower quality of life (Catastrophisers 61.96 95% CI 52.04 – 71.87; non-catastrophisers 75.79 95% CI 71.91 – 79.66 p=0.002). Conclusion The addition of NM to cervical and thoracic mobilisation, exercises and advice to stay active, in the management of cervico-brachial pain, resulted in less pain at 6-month follow-up. For patients with neuropathic pain the positive effect was more pronounced. Adding NM as an adjunct to usual care is effective to improve pain for patients with cervico-brachial pain especially for those with a neuropathic pain component. The presence of neuropathic pain and catastrophising resulted in poor pain-related outcomes. / MT2017

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiii, 70 leaves ; 30 cm / Although studies of manipulation-induced peripheral changes in the muscles have been done, inconsistencies noted by the author’s call for further investigation into the reflex effects of manipulation. Additionally, according to the literature, no effective treatment protocol for the painful shoulder has been found. Therefore this research aimed at addressing these discrepancies by quantifying the immediate effect of cervical spine manipulation in terms of peak torque on rotator cuff musculature in asymptomatic patients with both a cervical spine dysfunction and without. And thus by investigating cervical manipulation to the C4-C7 spinal segment, as a possible added intervention for improving rotator cuff muscle peak torque, a more efficient and effective management protocol for the painful shoulder could be attained. Thus the aims for this study included: 1) To evaluate whether manipulation has an effect on rotator cuff peak torque or not, utilizing the Cybex Orthotron II Isokinetic Rehabilitation System; 2) To ascertain whether manipulation of the specific levels has an effect on the rotator cuff peak torque or not and 3) To ascertain whether the presence or absence

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2003. 104 leaves / Whiplash injuries are thought to occur in as many as one-fifth of all MVA’s in the United States and Canada. South Africa may have a higher incidence of whiplash injuries due to the exceptionally high road accident rate when compared with international norms (Burger 1996:478). The incidence rate is higher among female subjects and people aged 20-24 years (Teasell and Shapiro 1998: 72, Spitzer et al. 1995). Whiplash injuries or whiplash-associated disorders (WAD) often result in chronic pain with a poor response to conventional therapeutics. Manipulation, exercise and anti-inflammatories have been identified as the options with scientifically established validity in the management of WAD (Spitzer et al. 1995) Patients with WAD have a distortion of the posture control system as a result of disorganised neck proprioceptive activity. It would therefore appear that proprioceptive rehabilitative exercises would benefit WAD sufferers (Revel et al. 1994, Gimse et al. 1996). Spinal manipulation has also been shown to have a significant effect on proprioceptive-dependent abilities in subjects with chronic neck pain (Rogers 1997). This suggests that a combination of manipulation and proprioceptive rehabilitation may offer an improved treatment protocol for WAD (Fitz-Ritson 1995). The purpose of this investigation is to evaluate the relative effectiveness of proprioceptive exercises and cervical spine manipulation compared to manipulation alone, in terms of subjective and objective measures, in the treatment of whiplash-associated disorders.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background Literature has shown that clinical and radiological diagnoses do not always correlate in patients with neck pain (Ferrari and Russel, 2003; Peterson and Hsu, 2004). It is not known if this applies to the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT) and if the radiological diagnosis leads to a change in the patient’s initial management plan. The impact of cervical spine plain film radiographs will therefore be investigated in the diagnosis and management of patients that presented with neck pain to the CDC at the DUT. It is also not known whether the reason for referral for cervical spine plain film radiographs is always indicated as per the indications in the clinic handbook and radiological referral guidelines. Objectives Objectives were: (1) To determine the suspected pre-radiographic clinical diagnosis and management of the selected clinical records prior to referral for cervical spine plain film radiography; (2) To record the reasoning to send for cervical spine plain film radiographic imaging and to establish whether these are in line with proposed guidelines for referral as found in the literature; (3) To determine the relationship between the suspected pre-radiographic clinical and the radiological diagnoses of patients with neck pain; (4) To determine the number of incidental findings in the selected patients’ plain film radiographs; (5) To determine any change in the pre-radiographic clinical diagnoses and management following radiological reporting of the selected patient’s plain film radiographs. Method This was a quantitative, retrospective, clinical study. The archives at the CDC at the DUT were searched for cervical spine plain film radiographs between 1 January 1997 to 31 December 2013 and these were matched with the corresponding clinical records. After applying the inclusion and exclusion criteria, 73 records were included in the study. The patient’s personal information was coded to ensure confidentiality (Appendix A) and specific clinical and radiological information was recorded (Appendix B). Statistical analysis included the use of frequency counts, percentages, mean, standard deviation and range for the descriptive objectives. Results A total of 73 clinical files and corresponding plain film radiographs were assessed. The mean age of the patients was 44 years. The gender distribution was 64.4% (n=47) females and 35.6% (n=26) males. The most frequent primary radiological diagnosis was loss of lordosis at 41.1% (n=30) followed by cervical spondylosis at 35.6% (n=26) and old cervical spinal trauma at 12.3% (n=9). Sixty four percent (n=47) of patients in this study were sent for cervical spine plain film radiographs after their initial clinical consultation. Reasons that are not considered relevant indications for plain film radiographic referral were present in 46.2% (n=34) of cases; these described non-specific mechanical disorders. The most common reason for plain film radiographic referral was due to positive orthopaedic tests 57.5% (n=42). A total of 27.4% (n=20) of clinical files reviewed had a change in their initial clinical diagnosis and 72.6% (n=53) of these patients had no change in diagnosis. All of the post-radiographic clinical diagnoses were non-specific mechanical conditions. Numerous treatment modalities were utilized by the students with the most common pre-radiographic treatment being soft tissue therapy at 63.0% (n=46). A total of 75% (n=55) of patients had a change of treatment after plain film radiographs were performed and spinal manipulative therapy (SMT) was the main treatment added in 41% of cases. Conclusion Cervical spine plain film radiographs have little impact on the diagnosis of patients with non-specific mechanical neck pain without red flags. It was however found that plain film radiographs had an impact on the management in the majority of cases, especially with an increase in SMT use after plain film radiographs. / M