Acute effects of single and multiple level thoracic manipulations on chronic mechanical neck pain: a randomized controlled trial

Background: Thoracic spine manipulation has become a popular alternative to local cervical manipulative therapy for mechanical neck pain. This study investigated the acute effects of single-level and multiple-level thoracic manipulations on chronic mechanical neck pain (CMNP). Methods: Forty-eight patients with CMNP were randomly allocated to single-level thoracic manipulation (STM) at T6–T7 or multiple-level thoracic manipulation (MTM), or to a control group (prone lying). Cervical range of motion (CROM), visual analog scale (VAS), and the Thai version of the Neck Disability Index (NDI-TH) scores were measured at baseline, and at 24-hour and at 1-week follow-up. Results: At 24-hour and 1-week follow-up, neck disability and pain levels were significantly (P<0.05) improved in the STM and MTM groups compared with the control group. CROM in flexion and left lateral flexion were increased significantly (P<0.05) in the STM group when compared with the control group at 1-week follow-up. The CROM in right rotation was increased significantly after MTM compared to the control group (P<0.05) at 24-hour follow-up. There were no statistically significant differences in neck disability, pain level at rest, and CROM between the STM and MTM groups. Conclusion: These results suggest that both single-level and multiple-level thoracic manipulation improve neck disability, pain levels, and CROM at 24-hour and 1-week follow-up in patients with CMNP.Rungthip Puntumetakul, Thavatchai Suvarnnato, Phurichaya Werasirirat, Sureeporn Uthaikhup, Junichiro Yamauchi, Rose Boucau

Prevalence and risk factor analysis of lower extremity abnormal alignment characteristics among rice farmers

BACKGROUND: Rice farming activities involve prolonged manual work and human-machine interaction. Prolonged farming risk-exposure may result in lower limb malalignment. This malalignment may increase the risk of lower extremity injury and physical disabilities. However, the prevalence and factors associated with lower extremity malalignment have not yet been reported. This study aimed to investigate the prevalence and risk factors of lower extremity malalignment among rice farmers. METHODS: A cross-sectional survey was conducted with 249 rice farmers. Lower extremity alignment assessment included: pelvic tilt angle, limb length equality, femoral torsion, quadriceps (Q) angle, tibiofemoral angle, genu recurvatum, rearfoot angle, and medial longitudinal arch angle. Descriptive statistics were used to analyze participant characteristics and prevalence of lower extremity malalignment. Logistic regression analysis was used to identify risk factors. RESULTS: The highest prevalence of lower extremity malalignment was foot pronation (36.14%), followed by the abnormal Q angle (34.94%), tibiofemoral angle (31.73%), pelvic tilt angle (30.52%), femoral antetorsion (28.11%), limb length inequality (22.49%), tibial torsion (21.29%), and genu recurvatum (11.24%). In females, the risk factors were abnormal Q angle, tibiofemoral angle, and genu recurvatum. Being overweight was a risk factor for abnormal pelvic tilt angle, Q angle, and tibiofemoral angle. Age was a risk factor for limb length inequality. Years of farming were a major risk factor for abnormal Q angle, tibiofemoral angle, and foot malalignment. CONCLUSION: Prevalence of lower extremity malalignment was reported in this study. Female sex, being overweight, and years of farming were major risk factors for lower extremity malalignment. Lower extremity screening should assist in the identification of foot and knee malalignment in rice farmers. This may then lead to early prevention of musculoskeletal disorders arising from such malalignment.Usa Karukunchit, Rungthip Puntumetakul, Manida Swangnetr, Rose Boucau

The effects of thoracic manipulation versus mobilization for chronic neck pain: a randomized controlled trial pilot study

[Purpose] To investigate effects of thoracic manipulation versus mobilization on chronic neck pain. [Methods] Thirty-nine chronic neck pain subjects were randomly assigned to single level thoracic manipulation, single level thoracic mobilization, or a control group. The cervical range of motion (CROM) and pain ratings (using a visual analog scale: VAS) were measured before, immediately after and at a 24-hour follow-up. [Results] Thoracic manipulation significantly decreased VAS pain ratings and increased CROM in all directions in immediate and 24-hour follow-ups. The thoracic mobilization group significantly increased in CROM in most directions at immediate follow-up and right and left rotational directions at the 24-hour follow-up. Comparisons between groups revealed the CROM for the manipulation group to increase significantly more than for control subjects in most directions at immediate follow-up and flexion, left lateral flexion and left rotation at the 24-hour follow-up. The CROM for the thoracic mobilization group significantly increased in comparison to the control group in flexion at immediate follow-up and in flexion and left rotation at the 24-hour follow-up. [Conclusion] The study demonstrated reductions in VAS pain ratings and increases in CROM at immediate and 24-hour follow-ups from both single level thoracic spine manipulation and thoracic mobilization in chronic neck pain.Thavatchai Suvarnnato, Rungthip Puntumetakul, David Kaber, Rose Boucaut, Yodchai Boonphakob, Preeda Arayawichanon, Uraiwan Chatchawa

Prevalence and risk factor analysis of lower extremity abnormal alignment characteristics among rice farmers

Usa Karukunchit,1,2 Rungthip Puntumetakul,1,3 Manida Swangnetr,1,4 Rose Boucaut5 1Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), 2Faculty of Associated Medical Sciences, Khon Kaen University, 3School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, 4Department of Production Technology, Faculty of Technology, Khon Kaen University, Khon Kaen, Thailand; 5School of Health Sciences (Physiotherapy), iCAHE (International Centre for Allied Health Evidence), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia Background: Rice farming activities involve prolonged manual work and human&ndash;machine interaction. Prolonged farming risk-exposure may result in lower limb malalignment. This malalignment may increase the risk of lower extremity injury and physical disabilities. However, the prevalence and factors associated with lower extremity malalignment have not yet been reported. This study aimed to investigate the prevalence and risk factors of lower extremity malalignment among rice farmers.Methods: A cross-sectional survey was conducted with 249 rice farmers. Lower extremity alignment assessment included: pelvic tilt angle, limb length equality, femoral torsion, quadriceps (Q) angle, tibiofemoral angle, genu recurvatum, rearfoot angle, and medial longitudinal arch angle. Descriptive statistics were used to analyze participant characteristics and prevalence of lower extremity malalignment. Logistic regression analysis was used to identify risk factors.Results: The highest prevalence of lower extremity malalignment was foot pronation (36.14%), followed by the abnormal Q angle (34.94%), tibiofemoral angle (31.73%), pelvic tilt angle (30.52%), femoral antetorsion (28.11%), limb length inequality (22.49%), tibial torsion (21.29%), and genu recurvatum (11.24%). In females, the risk factors were abnormal Q angle, tibiofemoral angle, and genu recurvatum. Being overweight was a risk factor for abnormal pelvic tilt angle, Q angle, and tibiofemoral angle. Age was a risk factor for limb length inequality. Years of farming were a major risk factor for abnormal Q angle, tibiofemoral angle, and foot malalignment.Conclusion: Prevalence of lower extremity malalignment was reported in this study. Female sex, being overweight, and years of farming were major risk factors for lower extremity mal&shy;alignment. Lower extremity screening should assist in the identification of foot and knee mal&shy;alignment in rice farmers. This may then lead to early prevention of musculoskeletal disorders arising from such malalignment. Keywords: lower extremity malalignment, prevalence, rice farmer, risk factors&nbsp

Effect of specific deep cervical muscle exercises on functional disability, pain intensity, craniovertebral angle, and neck-muscle strength in chronic mechanical neck pain: a randomized controlled trial

Thavatchai Suvarnnato,1 Rungthip Puntumetakul,1 Sureeporn Uthaikhup,2 Rose Boucaut3 1School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; 2School of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; 3School of Health Sciences (Physiotherapy), University of South Australia, Adelaide, SA, Australia Background: Exercise is known to be an important component of treatment programs for individuals with neck pain. The study aimed to compare the effects of semispinalis cervicis (extensor) training, deep cervical flexor (flexor) training, and usual care (control) on functional disability, pain intensity, craniovertebral (CV) angle, and neck-muscle strength in chronic mechanical neck pain.Methods: A total of 54 individuals with chronic mechanical neck pain were randomly allocated to three groups: extensor training, flexor training, or control. A Thai version of the Neck Disability Index, numeric pain scale (NPS), CV angle, and neck-muscle strength were measured at baseline, immediately after 6 weeks of training, and at 1- and 3 -month follow-up.Results: Neck Disability Index scores improved significantly more in the exercise groups than in the control group after 6 weeks training and at 1- and 3-month follow-up in both the extensor (P=0.001) and flexor groups (P=0.003, P=0.001, P=0.004, respectively). NPS scores also improved significantly more in the exercise groups than in the control group after 6 weeks&rsquo; training in both the extensor (P&lt;0.0001) and flexor groups (P=0.029. In both exercise groups, the CV angle improved significantly compared with the control group at 6 weeks and 3 months (extensor group, P=0.008 and P=0.01, respectively; flexor group, P=0.002 and 0.009, respectively). At 1 month, the CV angle had improved significantly in the flexor group (P=0.006). Muscle strength in both exercise groups had improved significantly more than in the control group at 6 weeks and 1- and 3-month follow-up (extensor group, P=0.04, P=0.02, P=0.002, respectively; flexor group, P=0.002, P=0.001, and 0.001, respectively). The semispinalis group gained extensor strength and the deep cervical flexor group gained flexor strength.Conclusion: The results suggest that 6 weeks of training in both exercise groups can improve neck disability, pain intensity, CV angle, and neck-muscle strength in chronic mechanical neck pain.Trial registration: NCT02656030 Keywords: specific training, deep-neck muscles, chronic neck pain &nbsp

Preliminary study: comparative effects of lung volume therapy between slow and fast deep-breathing techniques on pulmonary function, respiratory muscle strength, oxidative stress, cytokines, 6-minute walking distance, and quality of life in persons with COPD

Jirakrit Leelarungrayub,1 Rungthip Puntumetakul,2 Thanyaluck Sriboonreung,1 Yothin Pothasak,1 Jakkrit Klaphajone3 1Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; 2Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand; 3Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Background: Lung volume therapy with the Voldyne&reg; device can improve lung volume and has a nonsignificant benefit on respiratory muscle strength via the slow deep-breathing technique (SDBT); whereas respiratory muscle training with a respiratory muscle trainer via the fast deep-breathing technique (FDBT) has produced a significant improvement in people with COPD. Thus, the aim of this study was to compare the efficiency of lung volume therapy with the Voldyne&reg; device with the SDBT and FDBT on pulmonary function, respiratory muscle strength, oxidative stress, cytokines, walking capacity, and quality of life (QoL) in people with COPD. Methods: A total of 30 COPD patient volunteers with mild (stage I) to moderate (stage II) severity were randomized into two groups: SDBT (n=15) and FDBT (n=15). Pulmonary function (FVC, FEV1, and FEV1/FVC), maximal inspiratory mouth pressure (PImax), oxidative stress status (total antioxidant capacity [TAC], glutathione [GSH], malondialdehyde [MDA], and nitric oxide [NO]), inflammatory cytokines (tumor necrosis factor-alpha [TNF-&alpha;] and IL-6), 6-minute walking distance (6MWD), and total clinical COPD questionnaire (CCQ) score were evaluated before and after 4 weeks of training. Results: All the parameters had no statistical difference between the groups before training. The PImax, TAC, IL-6, total QoL score, and 6MWD changed significantly in the SDBT group after the 4-week experiment as compared to those in the pre-experimental period, whereas FVC, FEV1, FEV1%, FEV1/FVC%, PImax, TAC, MDA, NO, TNF-&alpha;, IL-6, 6MWD, and total CCQ score changed significantly in the FDBT group as compared to those in the pre-experimental period. The FEV1%, PImax, TNF-&alpha;, IL-6, and total CCQ score differed significantly in the FDBT group in the post-experimental period as compared to those in the SDBT group. Conclusion: This preliminary study concluded that the application of incentive spirometry with the Voldyne&reg; device via fast deep breathing possibly improved respiratory muscle strength and QoL and reduced inflammatory cytokines, MDA, and NO better than that via slow deep breathing among people with COPD. Keywords: COPD, cytokines, incentive spirometry, oxidative stress, 6-minute walking distance, quality of lif

Acute effects of single and multiple level thoracic manipulations on chronic mechanical neck pain: a&nbsp;randomized controlled trial

Rungthip Puntumetakul,1,2 Thavatchai Suvarnnato,1,3 Phurichaya Werasirirat,1 Sureeporn Uthaikhup,2 Junichiro Yamauchi,4,5 Rose Boucaut6 1School of Physical Therapy, Faculty of Associated Medical Sciences, 2Research Center in Back, Neck, Other Joint Pain and Human Performance, 3Physical Therapy Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 4Graduate School of Human Health Sciences, Tokyo Metropolitan University, 5Future Institute for Sport Sciences, Tokyo, Japan; 6School of Health Sciences (Physiotherapy), University of South Australia, Adelaide, SA, Australia Background: Thoracic spine manipulation has become a popular alternative to local cervical manipulative therapy for mechanical neck pain. This study investigated the acute effects of single-level and multiple-level thoracic manipulations on chronic mechanical neck pain (CMNP).Methods: Forty-eight patients with CMNP were randomly allocated to single-level thoracic manipulation (STM) at T6&ndash;T7&nbsp;or multiple-level thoracic manipulation (MTM), or to a control group (prone lying). Cervical range of motion (CROM), visual analog scale (VAS), and the Thai version of the Neck Disability Index (NDI-TH) scores were measured at baseline, and at 24-hour and at 1-week follow-up.Results: At 24-hour and 1-week follow-up, neck disability and pain levels were significantly (P&lt;0.05) improved in the STM and MTM groups compared with the control group. CROM in flexion and left lateral flexion were increased significantly (P&lt;0.05) in the STM group when compared with the control group at 1-week follow-up. The CROM in right rotation was increased significantly after MTM compared to the control group (P&lt;0.05) at 24-hour follow-up. There were no statistically significant differences in neck disability, pain level at rest, and CROM between the STM and MTM groups.Conclusion: These results suggest that both single-level and multiple-level thoracic manipulation improve neck disability, pain levels, and CROM at 24-hour and 1-week follow-up in patients with CMNP. Keywords: thoracic manipulation, neck disability, pain level, neck pai

A preliminary study on the effects of star fruit consumption on antioxidant and lipid status in elderly Thai individuals

Jirakrit Leelarungrayub,1 Araya Yankai,1 Decha Pinkaew,1 Rungthip Puntumetakul,2 James J Laskin,3 Richard J Bloomer4 1Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 2Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand; 3School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT, 4Cardiorespiratory/Metabolic Laboratory, School of Health Studies, University of Memphis, Memphis, TN, USA Objective: The aims of this preliminary study were to evaluate the antioxidant and lipid status before and after star fruit juice consumption in healthy elderly subjects, and the vitamins in star fruit extracts.Methods: A preliminary designated protocol was performed in 27 elderly individuals with a mean (&plusmn;SD) age of 69.5&plusmn;5.3 years, by planning a 2-week control period before 4 weeks of consumption of star fruit twice daily. Oxidative stress parameters such as total antioxidant capacity, glutathione, malondialdehyde, protein hydroperoxide, multivitamins such as L-ascorbic acid (Vit C), retinoic acid (Vit A), and tocopherol (Vit E), and the lipid profile parameters such as cholesterol, triglyceride, high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) were analyzed. Moreover, Vit C, Vit A, and Vit E levels were evaluated in the star fruit extracts during the 4-week period.Results: In the 2-week control period, all parameters showed no statistically significant difference; after 4 weeks of consumption, significant improvement in the antioxidant status was observed with increased total antioxidant capacity and reduced malondialdehyde and protein hydroperoxide levels, as well as significantly increased levels of Vit C and Vit A, when compared to the two-time evaluation during the baseline periods. However, glutathione and Vit E showed no statistical difference. In addition, the HDL-C level was higher and the LDL-C level was significantly lower when compared to both baseline periods. But the levels of triglyceride and cholesterol showed no difference. Vit C and Vit A were identified in small quantities in the star fruit extract.Conclusion: This preliminary study suggested that consumption of star fruit juice twice daily for 1 month improved the elderly people&rsquo;s antioxidant status and vitamins, as well as improved the lipoproteins related to Vit C and Vit A in the star fruit extract. Keywords: star fruit, elderly, antioxidants, vitamins, lipid, oxidative stres

Prevalence and individual risk factors associated with clinical lumbar instability in rice farmers with low back pain

Rungthip Puntumetakul,1 Wantanee Yodchaisarn,1 Alongkot Emasithi,2 Petcharat Keawduangdee,1 Uraiwan Chatchawan,1 Junichiro Yamauchi3 1The Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand; 2School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; 3Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan Introduction: Clinical lumbar instability (CLI) is one of the subgroups of chronic non-specific low back pain. Thai rice farmers often have poor sustained postures during a rice planting process and start their farming at an early age. However, individual associated factors of CLI are not known and have rarely been diagnosed in low back pain. This study aimed to determine the prevalence and individual associated factors of CLI in Thai rice farmers. Methods: A cross-sectional survey was conducted among 323 Thai rice farmers in a rural area of Khon Kaen province, Thailand. Face-to-face interviews were conducted using the 13-item Delphi criteria questionnaire, after which an objective examination was performed using aberrant movement sign, painful catch sign, and prone instability test to obtain information. Individual factors such as sex, body mass index, waist-hip ratio, smoking, and number of years of farming experience, were recorded during the face-to-face interview. Results: The prevalence of CLI in Thai rice farmers calculated by the method described in this study was 13% (age 44&plusmn;10 years). Number of years of farming experience was found to be significantly correlated with the prevalence of CLI (adjusted odds ratio =2.02, 95% confidence interval =1.03&ndash;3.98, P&lt;0.05). Conclusion: This study provides prevalence of CLI in Thai rice farmers. Those with long-term farming experience of at least 30 years have a greater risk of CLI. Keywords: Delphi study, aberrant movement sign, painful catch sign, prone instability tes