Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study.

Background: Spinal manipulation for nonspecific neck pain is thought to work in part by improving inter-vertebral range of motion (IV-RoM), but it is difficult to measure this or determine whether it is related to clinical outcomes. Objectives: This study undertook to determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation, to explore relationships between any IV-RoM increases and clinical outcomes and to compare palpation with objective measurement in the detection of hypo-mobile segments. Method: Thirty patients with nonspecific neck pain and 30 healthy controls matched for age and gender received quantitative fluoroscopy (QF) screenings to measure flexion and extension IV-RoM (C1-C6) at baseline and 4-week follow-up between September 2012-13. Patients received up to 12 neck manipulations and completed NRS, NDI and Euroqol 5D-5L at baseline, plus PGIC and satisfaction questionnaires at follow-up. IV-RoM accuracy, repeatability and hypo-mobility cut-offs were determined. Minimal detectable changes (MDC) over 4 weeks were calculated from controls. Patients and control IV-RoMs were compared at baseline as well as changes in patients over 4 weeks. Correlations between outcomes and the number of manipulations received and the agreement (Kappa) between palpated and QF-detected of hypo-mobile segments were calculated. Results: QF had high accuracy (worst RMS error 0.5o) and repeatability (highest SEM 1.1o, lowest ICC 0.90) for IV-RoM measurement. Hypo-mobility cut offs ranged from 0.8o to 3.5o. No outcome was significantly correlated with increased IV-RoM above MDC and there was no significant difference between the number of hypo-mobile segments in patients and controls at baseline or significant increases in IV-RoMs in patients. However, there was a modest and significant correlation between the number of manipulations received and the number of levels and directions whose IV-RoM increased beyond MDC (Rho=0.39, p=0.043). There was also no agreement between palpation and QF in identifying hypo-mobile segments (Kappa 0.04-0.06). Conclusions: This study found no differences in cervical sagittal IV-RoM between patients with non-specific neck pain and matched controls. There was a modest dose-response relationship between the number of manipulations given and number of levels increasing IV-RoM - providing evidence that neck manipulation has a mechanical effect at segmental levels. However, patient-reported outcomes were not related to this

Strain-induced pseudomagnetic field and Landau levels in photonic structures

Magnetic effects at optical frequencies are notoriously weak. This is evidenced by the fact that the magnetic permeability of nearly all materials is unity in the optical frequency range, and that magneto-optical devices (such as Faraday isolators) must be large in order to allow for a sufficiently strong effect. In graphene, however, it has been shown that inhomogeneous strains can induce 'pseudomagnetic fields' that behave very similarly to real fields. Here, we show experimentally and theoretically that, by properly structuring a dielectric lattice, it is possible to induce a pseudomagnetic field at optical frequencies in a photonic lattice, where the propagation dynamics is equivalent to the evolution of an electronic wavepacket in graphene. To our knowledge, this is the first realization of a pseudomagnetic field in optics. The induced field gives rise to multiple photonic Landau levels (singularities in the density of states) separated by band gaps. We show experimentally and numerically that the gaps between these Landau levels give rise to transverse confinement of the optical modes. The use of strain allows for the exploration of magnetic effects in a non-resonant way that would be otherwise inaccessible in optics. Employing inhomogeneous strain to induce pseudomagnetism suggests the possibility that aperiodic photonic crystal structures can achieve greater field-enhancement and slow-light effects than periodic structures via the high density-of-states at Landau levels. Generalizing these concepts to other systems beyond optics, for example with matter waves in optical potentials, offers new intriguing physics that is fundamentally different from that in purely periodic structures.Comment: 24 pages including supplementary information section, 4 figure

A Reliable and Inexpensive Integration of Virtual Reality and Digital Human Modelling to Estimate Cervical Spine Function

Musculoskeletal disorders present one of the most prominent impact among the work-related diseases. Cervical spine is indeed one of the anatomical regions most affected by these issues; the main impairments concerning the cervical segment inherently limit its ranges of motion (ROMs). In the last years, novel technologies have been developed to support clinicians in assessing and quantifying these limitations, including wearable sensors and Virtual Reality (VR). In this perspective, interest in Digital Human Modeling has been also increasing due to the possibility of using it together with wearable technologies, thus to obtain enhanced information on body dynamics. This study aimed to validate a novel approach, which integrated VR technology and multi-body modelling to reliably estimated the ROMs of the cervical spine during the execution of three specific tasks (i.e. flexion-extension, lateral bending, axial rotation). Comparison with standard optoelectronic system reported strong correlation and good reliability, with an average difference in estimating ROMs of 8.0° and a mean RMSE of 4.7°. Furthermore, a preliminary test in managing different visual cues through VR highlighted interesting trends for future developments. The performed analysis supported the use of the proposed solution for both the clinical settings and telemedicine applications