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de Sire A, Lippi L, Calafiore D, Marotta N, Mezian K, Chiaramonte R, Cisari C, Vecchio M, Ammendolia A, Invernizzi M. Dynamic spinal orthoses self-reported effects in patients with back pain due to vertebral fragility fractures: A multi-center prospective cohort study. J Back Musculoskelet Rehabil 2024; 37:929-941. [PMID: 38217575 DOI: 10.3233/bmr-230177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND Vertebral fragility fractures (VFFs) commonly result from low bone mass and microarchitecture deterioration of bone tissue. spinal orthoses are common non-pharmacological options for managing vertebral fracture pain. However, the effects of spinal orthoses on pain, physical functioning, and quality of life (QoL) are still debated. OBJECTIVE This survey aimed to investigate the patients-reported outcomes of a dynamic spinal orthosis prescribed in the routine clinical practice of VFFs management. METHODS This multi-center national-wide prospective cohort study assessed older patients (aged > 60 years) diagnosed with acute VFFs and prescribed with a dynamic spinal orthosis (Spinfast®). A survey questionnaire was realized and included sections on patient characterization, osteoporosis characterization, spinal orthosis, clinical outcomes, pain medications, and osteoporosis medications. The questionnaire was administered at baseline and after three months. A total of 68 patients completed the questionnaire at three months. Most patients had one or two VFFs and were treated with pain medications and osteoporosis medications. Compliance and tolerability of the spinal orthosis were assessed, and clinical outcomes such as pain intensity, physical functioning, and QoL were measured. RESULTS The results showed no significant differences in outcomes between age subgroups. Italian physical medicine and rehabilitation physicians were commonly involved in the management of VFFs patients. Sixty-six patients completed the questionnaire. The results showed that pain intensity, physical functioning and QoL improved after three months of spinal orthosis wearing (p< 0.0001). CONCLUSION The correct management of VFFs is mandatory to improve pain and reduce disability, and our findings suggested a positive role of dynamic spinal orthosis to improve the comprehensive management of VFFs patients. However, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University, Hospital Motol, Prague, Czech Republic
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical and Rehabilitative Medicine, Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Rita Chiaramonte
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Carlo Cisari
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Michele Vecchio
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Unit of Rehabilitation, AOU Policlinico G. Rodolico S.Marco, Catania, Italy
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Varma S, Tsang K, Peck G. Thoraco-lumbar-sacral orthoses in older people - A narrative literature review. Injury 2023; 54:110986. [PMID: 37579687 DOI: 10.1016/j.injury.2023.110986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 06/20/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023]
Abstract
Fractures in the thoracolumbar region have a bimodal distribution, with an increasing number of older people presenting with acute vertebral fractures after atraumatic or low energy mechanisms of injury. In the absence of neurological compromise and significant vertebral instability, thoracolumbar fractures are often managed conservatively and bracing is widely recommended. However, in older cohorts, bracing is often ill fitting and poorly tolerated with non-compliance leading to prolonged immobilization. Systematic reviews and meta-analyses have challenged the motive of bracing, but as evidence quality is low, the role of exploratory analysis has been limited. This descriptive review summarises and examines the current evidence that underpins the use of spinal orthoses, specific to older patients, in an effort to streamline its judicious use in clinical practice and identify scope to direct further research.
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Affiliation(s)
- Surabhi Varma
- Major Trauma Center, St. Mary's hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, U.K
| | - Kevin Tsang
- Major Trauma Center, St. Mary's hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, U.K
| | - George Peck
- Major Trauma Center, St. Mary's hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, U.K.
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de Sire A, Ammendolia A, Gimigliano A, Tiberi R, Cisari C, Invernizzi M. Spinal Orthoses Prescription for Vertebral Fragility Fractures by Italian Physical and Rehabilitation Medicine Physicians: The SPIN-VER Survey. Healthcare (Basel) 2021; 9:healthcare9070892. [PMID: 34356276 PMCID: PMC8303444 DOI: 10.3390/healthcare9070892] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/12/2023] Open
Abstract
Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fractures, related to pain and disability. In this scenario, physical and rehabilitative medicine (PRM) physicians prescribe a patient-tailored rehabilitation plan, including spinal orthoses. However, there is a high heterogeneity in the clinical indications of spinal orthoses. Thus, the aim of this survey was to investigate common clinical practice in terms of the prescription of spinal orthoses. This nationwide cross-sectional survey recruited Italian PRM physicians commonly involved in the management of patients with VFFs. One hundred twenty-six PRM physicians completed the survey. The results showed that most PRM physicians prescribe spinal orthoses in outpatients suffering from VFFs (n = 106; 83.9%). The most prescribed spinal orthosis for acute VFF patients was the three-point rigid orthosis (n = 64; 50.8%), followed by the semirigid thoraco-lumbar orthosis (n: 20; 15.9%). However, most PRM physicians prescribed dynamic orthoses in outpatients with chronic VFFs (n = 66; 52.4%). Albeit that a correct management of VFFs is mandatory to improve pain and reduce disability, our findings highlighted uncertainty in the type of spinal orthosis prescription in both the acute and chronic VFF phase. Therefore, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-096-171-2819
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | | | - Roberto Tiberi
- MyEvent SRL, Events Organization, Monte Porzio Catone, 00078 Rome, Italy;
| | - Carlo Cisari
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Samani M, Shirazi ZR, Hadadi M, Sobhani S. A randomized controlled trial comparing the long-term use of soft lumbosacral orthoses at two different pressures in patients with chronic nonspecific low back pain. Clin Biomech (Bristol, Avon) 2019; 69:87-95. [PMID: 31302494 DOI: 10.1016/j.clinbiomech.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/22/2019] [Accepted: 07/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is concern that wearing soft lumbosacral orthoses for prolonged periods may impair motor function. Moreover, the pressure applied by lumbosacral orthoses on the abdominal wall is usually ignored when these orthoses are prescribed. METHOD In this randomized controlled trial study, 48 patients with chronic nonspecific low back pain were randomly divided into high pressure, normal pressure and control groups. All groups received medication for 4 weeks. The normal pressure and high pressure groups, in addition to medication, used soft lumbosacral orthoses at normal pressure and 50% increased pressure, respectively. Motor function outcome measures were strength, endurance, proprioception and electromyographic activity of the trunk muscles. Clinical outcome measures were pain and disability, which were evaluated in two sessions before and after a 4-week interval. FINDINGS Isometric strength, endurance and most of the electromyographic parameters were generally unaffected by wearing the lumbosacral orthosis. Pain improved in all groups, and disability and proprioception improved in the high pressure and normal pressure groups. Between-group differences in these three measures indicated better results in the lumbosacral orthoses groups than in the control group. The improvements in pain and proprioception were significantly greater in the high pressure group than the normal pressure group. INTERPRETATION Long-term use of lumbosacral orthoses had no significant adverse effects on motor function or clinical factors in patients with chronic low back pain. Increasing lumbosacral orthosis tightness may improve motor functioning and the clinical efficacy of the orthosis. CLINICAL TRIAL REGISTRATION NUMBER Code: IRCT201708192391N38.
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Affiliation(s)
- Mahbobeh Samani
- Student Research Committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rojhani Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Hadadi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sobhan Sobhani
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Azadinia F, Ebrahimi E, Kamyab M, Parnianpour M, Cholewicki J, Maroufi N. Can lumbosacral orthoses cause trunk muscle weakness? A systematic review of literature. Spine J 2017; 17:589-602. [PMID: 27988341 DOI: 10.1016/j.spinee.2016.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/14/2016] [Accepted: 12/09/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Wearing lumbosacral orthosis (LSO) is one of the most common treatments prescribed for conservative management of low back pain. Although the results of randomized controlled trials suggest effectiveness of LSO in reducing pain and disability in these patients, there is a concern that prolonged use of LSO may lead to trunk muscle weakness and atrophy. PURPOSE The present review aimed to evaluate available evidence in literature to determine whether LSO results in trunk muscle weakness or atrophy. STUDY DESIGN This is a systematic review. METHODS A systematic search of electronic databases including PubMed, Scopus, ScienceDirect, and Medline (via Ovid) followed by hand search of journals was performed. Prospective studies published in peer-reviewed journals, with full text available in English, investigating the effect of lumbar orthosis on trunk muscle activity, muscle thickness, strength or endurance, spinal force, and intra-abdominal pressure in healthy subjects or in patients with low back pain, were included. Methodological quality of selected studies was assessed by using the modified version of Downs and Black checklist. This research had no funding source, and the authors declare no conflicts of interest-associated biases. RESULTS Thirty-five studies fulfilled the eligibility criteria. The mean and standard deviation of the quality score was 64±9.7%. Most studies investigating the effect of lumbar orthosis on electromyographic activity (EMG) of trunk muscles demonstrated a decrease or no change in the EMG parameters. A few studies reported increased muscle activity. Lumbosacral orthosis was found to have no effect on muscle strength in some studies, whereas other studies demonstrated increased muscle strength. Only one study, which included ultrasound assessment of trunk muscle stabilizers, suggested reduced thickness of the abdominal muscles and reduced cross-sectional area of the multifidus muscles. Out of eight studies that investigated spinal compression load, the load was reduced in four studies and unchanged in three studies. One study showed that only elastic belts reduced compression force compared to leather and fabric belts and ascribed this reduction to the elastic property of the lumbar support. CONCLUSION The present review showed that the changes in outcome measures associated with muscle work demands were inconsistent in their relation to the use of lumbar supports. This review did not find conclusive scientific evidence to suggest that orthosis results in trunk muscle weakness.
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Affiliation(s)
- Fatemeh Azadinia
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Ebrahimi
- Department of Physical therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Parnianpour
- Biomechanics Laboratory, Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Jacek Cholewicki
- MSU Center for Orthopedic Research, Department of Surgical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Nader Maroufi
- Department of Physical therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Blanchard TW, Smith C, Grenier SG. In a dynamic lifting task, the relationship between cross-sectional abdominal muscle thickness and the corresponding muscle activity is affected by the combined use of a weightlifting belt and the Valsalva maneuver. J Electromyogr Kinesiol 2016; 28:99-103. [PMID: 27093137 DOI: 10.1016/j.jelekin.2016.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 03/10/2016] [Accepted: 03/16/2016] [Indexed: 11/16/2022] Open
Abstract
It has been shown that under isometric conditions, as the activity of the abdominal muscles increases, the thicknesses of the muscles also increase. The purpose of this experiment was to determine whether change in muscle thickness could be used as a measure of muscle activity during a deadlift as well as determining the effect of a weightlifting belt and/or the Valsalva maneuver on the muscle thicknesses. The Transversus Abdominis (TrA) and Internal Obliques (IO) muscles were analyzed at rest and during a deadlift. Muscle thickness was measured using ultrasound imaging and muscle activity was simultaneously recorded using electromyography. Each subject performed deadlift under normal conditions, while performing the Valsalva maneuver, while wearing a weightlifting belt and while both utilizing the belt and the Valsalva maneuver. There was no relationship between change in muscle thickness and muscle activity for both the TrA and IO (R(2)<0.13 for all conditions). However it was found that the Valsalva maneuver increased abdominal muscle thickness whereas the belt limited muscle expansion; each with an increase in activity. These results indicate that ultrasound cannot be used to measure muscle activity for a deadlift and that the belt affects how the IO and TrA function together.
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Affiliation(s)
- Trevor W Blanchard
- Kinesiology, School of Human Kinetics, Laurentian University, Sudbury, Ontario, Canada
| | - Camille Smith
- Kinesiology, School of Human Kinetics, Laurentian University, Sudbury, Ontario, Canada
| | - Sylvain G Grenier
- Kinesiology, School of Human Kinetics, Laurentian University, Sudbury, Ontario, Canada.
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Shadmehr A, Jafarian Z, Tavakol K, Talebian S. Effect of Pelvic Compression on the Stability of Pelvis and Relief of Sacroiliac Joint Pain in Women: A Case Series. ACTA ACUST UNITED AC 2013. [DOI: 10.3109/10582452.2013.763395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kingma I, Faber GS, Suwarganda EK, Bruijnen TBM, Peters RJA, van Dieën JH. Effect of a stiff lifting belt on spine compression during lifting. Spine (Phila Pa 1976) 2006; 31:E833-9. [PMID: 17047531 DOI: 10.1097/01.brs.0000240670.50834.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An in vivo study on weightlifters. OBJECTIVES To determine if and how a stiff back belt affects spinal compression forces in weightlifting. SUMMARY OF BACKGROUND DATA In weightlifting, a back belt has been reported to enhance intraabdominal pressure (IAP) and to reduce back muscle EMG and spinal compression forces. METHODS Nine experienced weightlifters lifted barbells up to 75% body weight while inhaling and wearing a belt, inhaling and not wearing a belt, and exhaling and wearing a belt. IAP, trunk muscle EMG, ground reaction forces, and kinematics were measured. An EMG-assisted trunk model, including IAP effects, was used to calculate spinal compression and shear forces and to reveal the contribution of back muscles, abdominal muscles, and IAP to moment generation. RESULTS The belt reduced compression forces by about 10%, but only when inhaling before lifting. The moment generated by IAP increased when wearing a belt and inhaling, but this moment was small and the increase was largely negated by the flexing moment generated by abdominal muscles. CONCLUSIONS Wearing a tight and stiff back belt while inhaling before lifting reduces spine loading. This is caused by a moment generated by the belt rather than by the IAP.
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Affiliation(s)
- Idsart Kingma
- Institute of Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands.
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Smith DL, Dainoff MJ, Mark LS, Oates SP, Davis NC. Effect of a Back Belt on Reaching Postures. J Manipulative Physiol Ther 2004; 27:186-96. [PMID: 15129201 DOI: 10.1016/j.jmpt.2003.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The present study investigated the effect of a back belt on reach actions. SUBJECTS Sixteen undergraduate college students (8 male students, 8 female students) ranging in age from 18 to 22 years. Thirteen subjects were included in the final analysis. SETTING The Department of Psychology at Miami University, Oxford, Ohio METHODS Using a well-established set of procedures developed in our laboratory for studying reaching, seated adult participants reached for and retrieved an object placed at various distances from them. Reach distances included values both closer than and farther than each subject's maximum seated reach. The reach task had 2 conditions: picking up and retrieving a small block and skewering and retrieving a small bead with a needle. For each task condition, each subject either wore the belt or did not use a belt. RESULTS Results indicate that when subjects wore the belt while reaching, they tended to have initial transition points (sitting to nonsitting) closer to their bodies than while not wearing the belt. That is, for a distant object, subjects were more likely to raise their bodies out of the chair rather than perform an extreme seated reach, possibly acting to preserve a greater margin of safety. CONCLUSIONS The back belt consistently modified reaching postures by limiting extreme ranges of motion during a task that required enhanced stability. Furthermore, the methodology and analysis presented in this article when applied to chiropractic will allow us to begin thoughtful investigation of the effects of chiropractic adjustments on postural transitions and margin of safety.
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Affiliation(s)
- Dean L Smith
- Center for Ergonomic Research, Department of Psychology, Miami University, Oxford, Ohio, USA.
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