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(SMT) is most effective (Plamondon, 1995) The central focus of chiropractic practice is to determine when and where SMT is appropriate, and what type of adjustment is most appropriate in a given situation The most common form of chiropractic SMT is the high-velocity, low-amplitude thrust adjustment (HVLA), also known as osseous adjustment (Micozzi, 1996) It involves manual movement of a joint to the end point of its normal range of motion, followed by local pressure on bony prominences and then imparting a swift, speci c, low-amplitude thrust for joint cavitation Although patients often report signi cant functional improvements and healing effects following chiropractic adjustment, positive health changes have never been convincingly correlated with vertebral alignment (Micozzi, 1996; Winkel, Aufdemkampe, Matthijs, Meijer, & Phelps, 1996) Clinical Applications Several comprehensive reviews exist on clinical outcome studies in spinal manipulation.

Muscle bers remained intact, while connective tissue sheaths underwent coagulation and appeared granular These researchers reported the greatest effects were observed in samples heated to 73 C Sarcomeres exhibited thermally induced contraction and breakage at the Z-line, while some transverse lines remained intact Coagulation of the sarcolemma and exposure of myo brils were also observed Increased loss of sarcomeric structure was observed, with increased nal internal temperature Hearne et al (1978) also observed greater ber disintegration, with increased nal internal temperature Furthermore, these researchers found faster cooking rates to result in greater ber disintegration compared with slow rates of cooking to an endpoint of 60 C Bendall and Restall (1983) reported no change in sarcomere length when bers were heated, but diameter of bers changed markedly.

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Shekelle, Adams, Chassin, Hurwitz, and Brook (1992) analyzed nine randomized, controlled trials that tested the effects of spinal manipulation against various conservative treatments for patients with acute low back pain (eg, back pain that does not result from fractures, tumors, infections, and vascular, abdominal, or urinary diseases) All nine studies found spinal manipulation to be ef cacious, leading the authors to conclude that spinal manipulation hastens recovery from uncomplicated low back pain Findings from two other meta-analyses (Abenhaim & Bergeron, 1992; Anderson et al, 1992) provide some evidence of the short-term effectiveness of spinal manipulation in relieving acute and chronic back pain, although long-term effects of this treatment have not been adequately evaluated Chiropractic treatment has also been demonstrated to be more effective in treating the pain from muscle tension headaches than the tricyclic antidepressant amitriptyline for long-term relief of pain (Boline, 1991).

Myo bers heated in aqueous medium to nal temperatures of 40 C to 90 C resulted in a decrease in diameter of myo bers but no change in length These researchers con-.

In the dissected version, you can see that the fcb_downArrow symbol is made up of several skin elements. You can view the names of selected skin elements in the Property inspector. The fcb_downArrow symbol has six skin elements: arrow_mc, shadow_mc, darkshadow_mc, highlight_mc, and highlight3D_mc. Each skin symbol is a movie clip registered to the component and associated with properties of the FStyleFormat object in the Read Me file for the movie clip. To register a skin element to a component, you enter the name for the skin element in the first frame of the Read Me layer for the skin symbol which contains the skin element. The following code from the Read Me file for the fcb_downArrow symbol shows how the movie clip skin elements are registered to properties of the FStyleFormat object.

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Patients maintained their levels of improvement after treatment was discontinued, while those taking medication returned to pretreatment status in an average of four weeks following its discontinuation Further research is needed to address the question of long-term ef cacy of spinal manipulation for different types of pain Other studies have focused on applying chiropractic manipulation to spinal cord injury patients (Fritz-Ritson, 1995; Woo, 1993), infantile colic (Klougart, Nilsson, & Jacobsen, 1989), and enuresis (Leboeuf et al, 1991; Reed, Beavers, Reddy, & Kern, 1994) The results generated from these studies are inconsistent and inconclusive because of limitations in research design Further research is needed to.

Note: Antecedent variables are listed in alphabetical order. Italicized variables have been documented in sport contexts by the studies marked with an asterisk.

sional experience in hotels and restaurants, are the basis of this chapter. A chapter devoted to hospitality seems essential, since the staff of the front of ce very often represents the only direct contact the guest has with the hotel.

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