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Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002 xiii, 93 leaves / The purpose of this study was to determine the short to medium term effectiveness of Proprioceptive Neuromuscular Facilitaion (P.N.F.) stretching [using the Contract- Relax-Antagonist-Contract (C.R.A.C.) technique] as an adjunct treatment to cervical manipulation in the treatment of Mechanical Neck Pain.

Dissertation submitted to the Faculty of Health in compliance with the requirements for a Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2005 / Due to sustained partial neck flexion when operating a computer terminal for prolonged periods and by holding a stooped posture being proposed aetiologies for hypertonic posterior cervical muscles and subsequent mechanical neck pain, subjects for this research study were chosen according to their occupation and had to sit at a desk for more the three hours and less than eight hours a day. The purpose of this study was to investigate the effectiveness of proprioceptive neuromuscular facilitation combined with heat therapy as opposed to proprioceptive neuromuscular facilitation combined with cryotherapy in the treatment of mechanical neck pain caused by hypertonic posterior cervical muscles. This was a comparative, randomised, clinical trial consisting of two groups. Group A received proprioceptive neuromuscular facilitation (PNF) combined with heat therapy as their treatment protocol. Group B received proprioceptive neuromuscular facilitation combined with cryotherapy as their treatment protocol. Each group consisted of thirty people between the ages of 25 and 50 who were randomly allocated to their respective groups. It was hypothesized that the analgesic properties related to cryotherapy would result in the treatment group that received PNF stretching combined with cryotherapy yielding better results in terms of objective clinical findings. It was also hypothesized that the therapeutic effects of heat therapy would result in the treatment group receiving PNF stretching combined with heat therapy would yield better results in terms of subjective clinical findings and it is hypothesized that there is an association between the subjective and objective clinical findings between the cryotherapy and the heat therapy groups. The treatment regimen consisted of each participant receiving three treatments over a period of one week and then a one-week follow-up consultation. Subjective data monitored consisted of the Numerical Pain Rating Scale –101 (NRS-101) and the CMCC Neck Disability index. Objective data was collected using the Cervical Range of Motion goniometer (CROM) and the Algometer. At the end of all treatment protocols, statistical (quantitative) analysis was performed to determine whether one treatment protocol was more effective than the other. The analysis of the data collected showed that for all outcomes measured, either of the two treatments was effective overall. Trends suggested optimum treatments were dependent on the age of the patient. Age groups of 46-50 years old, 41-45 years old and the 31-35 years old responded best and improved the most with heat intervention, while age group of 36-40 years old responded best to the cryotherapy intervention. For the youngest age group of 25-30 years old, it did not make a difference whether they received heat therapy or cryotherapy as an intervention. It would seem that the older the patient the more effective the application of heat therapy as a result of the effect of heat therapy on the collagen and elastin fibers within the muscle and its fascia which allowed for increased and sustained improvement of the majority of the age groups represented in this study. Conversely it would seem that the cryotherapy group had only immediate and unsustained effects in the long term, which suggests that the cryotherapy had only a pain relieving function that allowed for the improvement of patients in the study, which when removed resulted in regression to the initial clinical syndrome severity. Most of the outcomes did not show a statistically significant interaction between time, age group and treatment group. The study was underpowered at the age group level, with only 12 subjects per age group. Further studies with a larger sample size in each of the age groups are needed in order to determine whether age is a definitive factor in one treatment being preferred over the other.

Inter-turbine diffusers or swan neck ducts (SND's) provide flow continuity between the H.P. and L.P. turbine, which with diffusing of the flow allow; greater stage efficiencies to be achieved as a consequence of reducing both the stage loading and flow coefficient of the L.P. turbine. This thesis presents an experimental and computational investigation into the local flow development and overall performance of two different severity diffusing annular sshaped ducts, with the same overall diffusion ratio of 1.5, in order to validate the CFD code M.E.F.P. The first less severe diffusing duct was used to investigate the effects of inlet swirl on the duct performance. It was found that at an optimum swirl angle of 15 degrees, the duct total pressure loss coefficient was approximately half the value at 0 or 30 degrees swirl. The second more severely diffusing duct had simple symmetrical aerofoil struts added, which simulated struts required in real inter-turbine diffusers to support inner shafts and supply vital engine services. The total pressure loss developed by the 30% shorter duct was 15% greater that of the longer duct, and when struts were added to the second duct the loss almost doubled. These increases were attributed to gradually worsening casing surface flow separations which also acted to reduce the overall static pressure recovery of the ducts as their losses increased. The computational investigations were made on the more severe duct with and without struts. The code, Moore's Elliptic Flow Solver (M.E.F.P) which used a mixing length model, predicted flow separation in the strutted duct case albeit in slightly the wrong position, however, it failed to predict any secondary flow for the unstrutted case and hence correlated worse with the measured results. This was also true of the results predicted by a version of Dawes BTOB3D.

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Whiplash injuries occur in automotive crashes and may cause long term health issues such as headache, neck pain, and visual and auditory disturbance. Whiplash-Associated Disorders are very costly and can impair the quality of human lives. Most studies focus on whiplash injuries that occur in neutral position head postures, although there is some evidence in the literature that non-neutral head posture can significantly increase the persistence of symptoms on patients. Crash dummies have limited biofidelity particularly for out-of-position scenarios and the current neck injury criteria were not derived for situations at which the head motion is not through the sagittal plane. Therefore Finite Element Methods provide an important tool that can be used to predict injury in different impact scenarios. The Finite Element model which was used for this study was previously developed at the University of Waterloo representing a 50th percentile male. The model had been previously validated at the segment level in extension, flexion, tension, and axial rotation. The full cervical spine model was validated in frontal and rear impact as well as tension. Since the final validation of the model, the ligament properties of the upper cervical spine and the muscle implementations had been improved to enhance the biofidelity of the model. To further improve the model, the addition of laxities to the ligaments of the upper cervical spine was studied. Several studies were performed based on the experiments in the literature to determine appropriate laxities for the upper cervical spine model. First, the laxities of -2 to 4 mm on all the ligaments were studied on the segment level of the model to find their effect on the failure force and displacement to failure in extension, flexion, tension, and axial rotation. The model development then went through a series of iterations in order to achieve laxity values that satisfied the failure force and displacement to failure reported in the literature for the four loading cases. Finally the laxities were used on a full cervical spine model and tested in physiological range of motion in extension, flexion, axial rotation, and lateral bending. The laxities were optimized using an iterative process. The results of this study provided laxity values that were acceptable in both segments level failure study and full cervical spine physiological range of motion study. The model was also validated against literature in impact scenarios. Using a cadaver experiment of 7 g rear impact, the global kinematics of the cervical spine was verified against the literature. The model provided good agreement with the head kinematics and relative rotations between the vertebrae for the cadaver tests. An 8 g rear impact cadaver test was used to validate the ligament strains and disc shear strains. For the anterior longitudinal ligament, the capsular ligament, and the disc shear strains, the model results were within one standard deviation of the literature in the majority of cervical spine regions that were reported. The model was also validated against volunteer low severity rear impact to verify the active musculature in the cervical spine. The head kinematics was generally within the boundaries that were reported by the literature. The model was compared to an experiment that used cadavers to investigate non-neutral rear impact scenarios. This experiment used cables and springs to replicate the passive behaviour of the musculature. The model showed good agreement with the extension and axial rotation results in both head kinematics and relative vertebrae rotations. The flexion and lateral bending results were not similar to the experimental data; attributed to the difference in muscle implementation between the two models. A total of 24 simulations were completed to find the effect of impact severity, axial rotation, and muscle activations on ligament strains during out-of-position rear impacts. The results illustrated that in general, ligament strains increased with the severity of impact and decreased with muscle activation. In out-of-position scenarios, the strains increased in some of the ligaments. An increase to the ligament strain as a result of non-neutral posture was mostly visible in the capsular ligaments of the upper cervical spine. The alar ligament and the apical ligaments of the upper cervical spine may fail in out-of-position at high rear impact scenarios. Recommendations for future work on the cervical spine Finite Element model includes the validation of the musculature and the usage of the muscles to rotate the head to a desired position to improve the biofidelity of the model and the results in out-of-position rear impacts. Further optimization of the laxities of the upper cervical spine can increase the biofidelity in this region. The modeling of the vertebral arteries into the FE model can help investigate whether out-of-position can increase the chance of injury of this region. The effect of flexion, extension, lateral bending, and their combination with axial rotation and the study of frontal and side impacts can be helpful in design of safer headrests for vehicles.

Temporomandibular disorders (TMD) consist of a group of pathologies affecting the masticatory muscles, the temporomandibular joint and related structures. The association between the cervical spine and TMD has been studied from different perspectives; however, the study of cervical muscles and their significance in the development and perpetuation of TMD has not been elucidated. Thus, this project was designed to investigate the association between cervical musculoskeletal impairments and TMD. A sample of subjects who attended the TMD/Orofacial Pain clinic, and students and staff at the University of Alberta participated in this study. All subjects underwent a series of physical tests and electromyographic assessment (i.e. head and neck posture, maximal cervical muscle strength, cervical flexor and extensor muscles endurance, and cervical flexor muscle performance) to determine cervical musculoskeletal impairments. All subjects were asked to complete the Neck disability Index and the Jaw Function Scale, and the Chronic Pain Grade Disability Questionnaire. A strong relationship between neck disability and jaw disability was found (r=0.82). Craniocervical posture (measured using the eye-tragus-horizontal angle) was statistically different between patients with myogenous TMD and healthy subjects. However, the difference was too small (3.3) to be considered clinically relevant. Maximal cervical flexor muscle strength was not statistically or clinically different between patients with TMD and healthy subjects. No statistically significant differences were found in electromyographic activity of the sternocleidomastoid or the anterior scalene muscles in patients with TMD when compared to healthy subjects while executing the craniocervical flexion test (p=0.07). However, clinically important effect sizes (0.42-0.82) were found. Subjects with TMD presented with reduced cervical flexor as well as extensor muscle endurance while performing the flexor and extensor muscle endurance tests when compared to healthy individuals. Furthermore, patients with mixed TMD presented with steeper negative slopes (although modest) at several times during the neck extensor muscle endurance test than healthy subjects. The results of this research provided an important clinical contribution to the area of physical therapy and TMD. It identified impairments in the cervical spine in patients with TMD that could help guide clinicians in the assessment and prescription of more effective interventions for individuals with TMD. / Rehabilitation Science

Neck manipulation is commonly used in the management of some musculoskeletal disorders to reduce pain and improve movement. There is, however, little understanding about the underlying mechanism. Recent research has alluded to a neurophysiological mechanism mediated through supraspinal pathways in the central nervous system, that may alter motor activity. The purpose of this study was to determine the effect of neck manipulation on the excitability of cortical motoneurons by means of activating corticospinal pathways to the flexor carpi radialis (FCR) muscle in an active motor system using the transcranial magnetic stimulation (TMS) technique.Motor evoked potentials (MEPs) were elicited by TMS and recorded in 20 normal subjects using established procedures. The peak-to-peak amplitude of MEPs were measured both before and after C6/7 manipulation and before and after neck positioning. Both interventions were applied to the normal subjects in random order on two different days. MEPs were recorded immediately after the intervention, then seven minutes and 14 minutes later to assess the time course of the effect. Five neck pain subjects participated in the manipulation experiments. The effects of manipulation, resulting in joint cavitation, were also explored. Two trials were undertaken before the intervention and these served as control measures. MEP data was represented in two ways. Firstly, 40 MEPs were averaged over 120 seconds; secondly, 15 MEPs were average over 60 seconds. A percentage change calculation was used to express the data relative to the baseline. Alterations in cortical excitability before and after manipulation were analysed by repeated measure analysis of variance (ANOVA) on the MEP data, and percentage change scores.Cortical neurons projecting to FCR were significantly facilitated up to 60 seconds after the manipulation of the non-painful segment, relative to baseline values and the positioning control. A small but significant latent increase in excitability was also observed 15 minutes after manipulation. The response to manipulation of the painful cervical segment was significantly different from that of the non-painful segment. When manipulation of the painful segment did not result in joint cavitation, an inhibitory effect was observed. In contrast, however, cortical motoneurons were facilitated when joint cavitation was associated with manipulation.In conclusion, motor activity is enhanced with neck manipulation when cortical motoneuron excitability is measured by TMS in human subjects performing a voluntary contraction. This may explain the clinically observed improvement in spinal motion and motor control with spinal manipulation. Further, joint cavitation may be important in signifying the success of the joint manipulation. The excitatory effect on cortical motoneurons is probably mediated through a transcortical pathway by means of the activation of muscle afferents with the manipulative thrust.These findings assist in understanding the neurophysiological mechanism underlying the effect of spinal manipulation.