Passive spezifische segmentale Bewegung in der HWS im Röntgenbild

Zusammenfassung

Die passive spezifische Mobilisation einzelner symptomatischer und/oder funktionsgestörter HWS-Segmente gilt als wichtige manualtherapeutische Technik. Unklar ist, ob eine solche Bewegung selektiv in einzelnen Segmenten möglich ist.

Die vorliegende Studie untersuchte dies an 6 gesunden Probanden, indem sagittale Röntgenfilme der aktiven und passiven HWS-Flexion bei manuell fixiertem Wirbel C3 aufgenommen wurden. Auf ausgewählten Bildern wurde der Unterschied in den Winkeln der Segmente C2–C3, C3–C4 und C4–C5 gemessen.

Bei der passiven Flexion mit Fixation von C3 bewegte das Segment C2–C3 signifikant mehr als bei der aktiven Flexion. Der Unterschied betrug allerdings nur 0,42 °. Die manuelle Fixation von C3 ergab im Segment C3 um 0,29 ° und im Segment C4 um 0,19 ° weniger Bewegung im Vergleich zur aktiven Flexion. Beide Werte waren statistisch nicht signifikant.

Reliabilität und Validität der segmentalen passiven Bewegung sind somit fraglich. Unklar bleibt, ob die passive Mobilisation der (Hals-)Wirbelsäule peripher mechanisch in der Wirbelsäule selbst oder eher zentral durch ein Wiederherstellen der kortikalen Funktion wirkt.

Abstract

Passive specific mobilisation of single symptomatic and/or functionally disturbed segments of the cervical spine is considered to be an important technique of manual therapy. It is unclear whether such a selective movement is possible in single segments.

This study investigated this in 6 healthy subjects using sagittal radiographic images of the active cervical flexion as well as passive flexion of the occiput with the manually fixed C3 vertebra. The difference of the segmental angles C2–C3, C3–C4 and C4–C5 was measured in selected images.

In passive flexion with fixed C3 the segment C2–C3 moved significantly more than in active flexion. Yet the difference was only 0.42 °. The manual fixation of C3 produced 0.29 ° less movement in segment C3 and 0.19 ° less movement in segment C4 compared to active flexion. Both values were not statistically significant.

Reliability and validity of the segmental passive movement is therefore doubtful. It remains disputable, whether the effects of passive (cervical) spine mobilisation originate peripheral mechanically in the spine itself or rather centrally as consequence of the restored cortical function.

Schlüsselwörter

HWS - passive segmentale Mobilisation - Spezifität - Röntgen

Keywords

cervical spine - passive segmental mobilisation - specificity - radiography

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