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Compagnon R, Brun-Cottan B, Assemat P, Vial J, Sales de Gauzy J, Swider P. Diffusion properties of asymptomatic lumbar intervertebral discs in a pediatric cohort: a preliminary study of apparent diffusion coefficient. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2943-2949. [PMID: 35939067 DOI: 10.1007/s00586-022-07342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To explore the apparent diffusion coefficients of intervertebral discs in an asymptomatic pediatric cohort. METHODS We conducted a prospective MRI study of the lumbar spine from below the thoracolumbar junction to the lumbosacral junction on 12 subjects (mean age 13 y.o.) with no spinal pathology or spinal posture disorder. MRI was carried out using a 1.5 T machine with acquisitions realized both in sagittal and coronal planes. First, disc hydration was determined, and then, diffusion-weighted images were obtained using an SE single-shot echo-planar sequence. Apparent diffusion coefficients (ADC) of anterior annulus fibrosus (AAF), nucleus pulposus (NP) and posterior annulus fibrosus (PAF) were measured in the sagittal plane. RESULTS Averaged hydration of 0.27 SD 0.03 confirmed the asymptomatic nature of discs. Average scaled values of ADC were 0.46 SD 0.01, 0.22 SD 0.09 and 0.18 SD 0.03 for NP, AAF and PAF, respectively. ADC of NP were almost constant along the spine; PAF values show a slight increase in the thorax-sacrum direction, while AAF values showed a pronounced decrease. Locally, ADC of AAF was higher compared to ADC PAF values below the thoracolumbar junction and it reversed for subjacent discs. CONCLUSIONS In our knowledge, our study provided the first diffusive properties of asymptomatic intervertebral discs in an adolescent cohort. ADC of NP was slightly higher than adults'. ADC evolutions of AAF were correlated with lordosis concavity which pointed out the role of compressive strain on fluid transport properties. This study could furnish information about segment homeostasis for exploration of pediatric spinal pathologies.
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Affiliation(s)
- Roxane Compagnon
- Children Hospital, Toulouse, France
- IMFT UMR CNRS 5502, Toulouse University, CHU Purpan, 2 Allées C. Soula, 31400, Toulouse, France
- Clinique Médipôle Garonne, Toulouse, France
| | - Baptiste Brun-Cottan
- IMFT UMR CNRS 5502, Toulouse University, CHU Purpan, 2 Allées C. Soula, 31400, Toulouse, France
| | - Pauline Assemat
- IMFT UMR CNRS 5502, Toulouse University, CHU Purpan, 2 Allées C. Soula, 31400, Toulouse, France
| | | | - Jérôme Sales de Gauzy
- Children Hospital, Toulouse, France
- IMFT UMR CNRS 5502, Toulouse University, CHU Purpan, 2 Allées C. Soula, 31400, Toulouse, France
| | - Pascal Swider
- IMFT UMR CNRS 5502, Toulouse University, CHU Purpan, 2 Allées C. Soula, 31400, Toulouse, France.
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Klett R. Bildgebung in der Manuellen Medizin – Notwendiges und Interessantes. DER ORTHOPADE 2022; 51:302-306. [DOI: 10.1007/s00132-022-04229-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
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Funabashi M, Breen AC, De Carvalho D, Pagé I, Nougarou F, Descarreaux M, Kawchuk GN. Force Distribution Within Spinal Tissues During Posterior to Anterior Spinal Manipulative Therapy: A Secondary Analysis. Front Integr Neurosci 2022; 15:809372. [PMID: 35185486 PMCID: PMC8855051 DOI: 10.3389/fnint.2021.809372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/31/2021] [Indexed: 12/20/2022] Open
Abstract
Background Previous studies observed that the intervertebral disc experiences the greatest forces during spinal manipulative therapy (SMT) and that the distribution of forces among spinal tissues changes as a function of the SMT parameters. However, contextualized SMT forces, relative to the ones applied to and experienced by the whole functional spinal unit, is needed to understand SMT’s underlying mechanisms. Aim To describe the percentage force distribution between spinal tissues relative to the applied SMT forces and total force experienced by the functional unit. Methods This secondary analysis combined data from 35 fresh porcine cadavers exposed to a simulated 300N SMT to the skin overlying the L3/L4 facet joint via servo-controlled linear motor actuator. Vertebral kinematics were tracked optically using indwelling bone pins. The functional spinal unit was then removed and mounted on a parallel robotic platform equipped with a 6-axis load cell. The kinematics of the spine during SMT were replayed by the robotic platform. By using serial dissection, peak and mean forces induced by the simulated SMT experienced by spinal structures in all three axes of motion were recorded. Forces experienced by spinal structures were analyzed descriptively and the resultant force magnitude was calculated. Results During SMT, the functional spinal unit experienced a median peak resultant force of 36.4N (IQR: 14.1N) and a mean resultant force of 25.4N (IQR: 11.9N). Peak resultant force experienced by the spinal segment corresponded to 12.1% of the total applied SMT force (300N). When the resultant force experienced by the functional spinal unit was considered to be 100%, the supra and interspinous ligaments experienced 0.3% of the peak forces and 0.5% of the mean forces. Facet joints and ligamentum flavum experienced 0.7% of the peak forces and 3% of the mean forces. Intervertebral disc and longitudinal ligaments experienced 99% of the peak and 96.5% of the mean forces. Conclusion In this animal model, a small percentage of the forces applied during a posterior-to-anterior SMT reached spinal structures in the lumbar spine. Most SMT forces (over 96%) are experienced by the intervertebral disc. This study provides a novel perspective on SMT force distribution within spinal tissues.
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Affiliation(s)
- Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Chiropractic Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- *Correspondence: Martha Funabashi,
| | | | - Diana De Carvalho
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Isabelle Pagé
- Chiropractic Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - François Nougarou
- Department of Electrical and Computer Engineering, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Human Kinetics Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Gregory N. Kawchuk
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
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Hadizadeh M, Kawchuk GN, Prasad N, Fritz JM. Predicting who responds to spinal manipulative therapy using a short-time frame methodology: Results from a 238-participant study. PLoS One 2020; 15:e0242831. [PMID: 33232379 PMCID: PMC7685475 DOI: 10.1371/journal.pone.0242831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background Spinal manipulative therapy (SMT) is among the nonpharmacologic interventions that has been recommended in clinical guidelines for patients with low back pain, however, some patients appear to benefit substantially more from SMT than others. Several investigations have examined potential factors to modify patients’ responses prior to SMT application. The objective of this study was to determine if the baseline prediction of SMT responders can be improved through the use of a restricted, non-pragmatic methodology, established variables of responder status, and newly developed physical measures observed to change with SMT. Materials and methods We conducted a secondary analysis of a prior study that provided two applications of standardized SMT over a period of 1 week. After initial exploratory analysis, principal component analysis and optimal scaling analysis were used to reduce multicollinearity among predictors. A multiple logistic regression model was built using a forward Wald procedure to explore those baseline variables that could predict response status at 1-week reassessment. Results Two hundred and thirty-eight participants completed the 1-week reassessment (age 40.0± 11.8 years; 59.7% female). Response to treatment was predicted by a model containing the following 8 variables: height, gender, neck or upper back pain, pain frequency in the past 6 months, the STarT Back Tool, patients’ expectations about medication and strengthening exercises, and extension status. Our model had a sensitivity of 72.2% (95% CI, 58.1–83.1), specificity of 84.2% (95% CI, 78.0–89.0), a positive likelihood ratio of 4.6 (CI, 3.2–6.7), a negative likelihood ratio of 0.3 (CI, 0.2–0.5), and area under ROC curve, 0.79. Conclusion It is possible to predict response to treatment before application of SMT in low back pain patients. Our model may benefit both patients and clinicians by reducing the time needed to re-evaluate an initial trial of care.
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Affiliation(s)
- Maliheh Hadizadeh
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory Neil Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
| | - Narasimha Prasad
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada
| | - Julie M. Fritz
- College of Health, University of Utah, Salt Lake City, Utah, United States of America
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Hinkeldey N, Okamoto C, Khan J. Spinal Manipulation and Select Manual Therapies: Current Perspectives. Phys Med Rehabil Clin N Am 2020; 31:593-608. [PMID: 32981581 DOI: 10.1016/j.pmr.2020.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Touch is fundamental to the doctor-patient relationship. Touch can produce neuromodulatory effects that mitigate pain and put patients at ease. Touch begins with a confident handshake and continues throughout the physical examination. Touching patients where they hurt is a clear indication that a provider understands their complaint. Touch often continues as a function of treatment. This article updates evidence surrounding human touch and addresses mechanisms of action for manual therapy, the impact of manual therapy on pain management, health care conditions for which manual therapy may be beneficial, treatment plans with dose-response evidence, and the impact of manual therapy on the health care system.
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Affiliation(s)
- Nathan Hinkeldey
- VA Central Iowa Health Care System, 3600 30th Street, Des Moines, IA 50310, USA; Palmer College of Chiropractic, 1000 Brady Street, Davenport, IA 52803, USA.
| | - Casey Okamoto
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN 55417, USA; Department of Rehabilitation Medicine, 500 Boynton Health Service Bridge, Minneapolis, MN 55455, USA
| | - Jamal Khan
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN 55417, USA; Department of Rehabilitation Medicine, 500 Boynton Health Service Bridge, Minneapolis, MN 55455, USA
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Nim CG, Kawchuk GN, Schiøttz-Christensen B, O'Neill S. The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial. Sci Rep 2020; 10:14615. [PMID: 32884045 PMCID: PMC7471938 DOI: 10.1038/s41598-020-71557-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/18/2020] [Indexed: 12/29/2022] Open
Abstract
The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back pain were randomly assigned to receive SMT at either the lumbar segment measured as the stiffest or the segment measured as having the lowest pain threshold. The primary outcome was patient reported low back pain intensity following treatment. Secondary outcomes were biomechanical stiffness and neurophysiological pressure pain threshold. All outcomes were measured at baseline, after the fourth and final session and at 2-weeks follow-up. Data were analyzed using linear mixed models, and demonstrated that the SMT application site did not influence patient reported low back pain intensity or stiffness. However, a large and significant difference in pressure pain threshold was observed between groups. This study provides support that SMT impacts neurophysiological parameters through a segment-dependent neurological reflex pathway, although this do not seem to be a proxy for improvement. This study was limited by the assumption that the applied treatment was sufficient to impact the primary outcome.
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Affiliation(s)
- Casper Glissmann Nim
- Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark.
| | | | | | - Søren O'Neill
- Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
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Aspinall SL, Leboeuf-Yde C, Etherington SJ, Walker BF. Changes in pressure pain threshold and temporal summation in rapid responders and non-rapid responders after lumbar spinal manipulation and sham: A secondary analysis in adults with low back pain. Musculoskelet Sci Pract 2020; 47:102137. [PMID: 32148330 DOI: 10.1016/j.msksp.2020.102137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/05/2020] [Accepted: 02/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND People with LBP who experience rapid improvement in symptoms after spinal manipulative therapy (SMT) are more likely to experience better longer-term outcomes compared to those who don't improve rapidly. It is unknown if short-term hypoalgesia after SMT could be a relevant finding in rapid responders. OBJECTIVES We aimed to explore whether rapid responders had different short-term pressure pain threshold (PPT) and temporal summation (TS) outcomes after SMT and sham compared to non-rapid responders. METHODS This was a planned secondary analysis of a randomised controlled trial that recruited 80 adults with LBP (42 females, mean age 37 yrs). PPT at the calf, lumbar spine, and shoulder and TS at the hands and feet were measured before and three times over 30 min after a lumbar SMT or sham manipulation. Participants were classified as rapid responders or non-rapid responders based on self-reported change in LBP over the following 24 h. RESULTS Shoulder PPT transiently increased more in the rapid responders than non-rapid responders immediately post-intervention only (between-group difference in change from baseline = 0.29 kg/cm2, 95% CI 0.02-0.56, p = .0497). There were no differences in calf PPT, lumbar PPT, hand TS, or foot TS based on responder status. CONCLUSIONS Hypoalgesia in shoulder PPT occurred transiently in the rapid responders compared to the non-rapid responders. This may or may not contribute to symptomatic improvement after SMT or sham in adults with LBP, and may be a spurious finding. Short-term changes in TS do not appear to be related to changes in LBP.
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Affiliation(s)
- Sasha L Aspinall
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia.
| | - Charlotte Leboeuf-Yde
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Sarah J Etherington
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia.
| | - Bruce F Walker
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia.
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Jun P, Pagé I, Vette A, Kawchuk G. Potential mechanisms for lumbar spinal stiffness change following spinal manipulative therapy: a scoping review. Chiropr Man Therap 2020; 28:15. [PMID: 32293493 PMCID: PMC7087370 DOI: 10.1186/s12998-020-00304-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/16/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION In individuals having low back pain, the application of spinal manipulative therapy (SMT) has been shown to reduce spinal stiffness in those who report improvements in post-SMT disability. The underlying mechanism for this rapid change in stiffness is not understood presently. As clinicians and patients may benefit from a better understanding of this mechanism in terms of optimizing care delivery, the objective of this scoping review of current literature was to identify if potential mechanisms that explain this clinical response have been previously described or could be elucidated from existing data. METHODS Three literature databases were systematically searched (MEDLINE, CINAHL, and PubMed). Our search terms included subject headings and keywords relevant to SMT, spinal stiffness, lumbar spine, and mechanism. Inclusion criteria for candidate studies were publication in English, quantification of lumbar spinal stiffness before and after SMT, and publication between January 2000 and June 2019. RESULTS The search identified 1931 articles. Of these studies, 10 were included following the application of the inclusion criteria. From these articles, 7 themes were identified with respect to potential mechanisms described or derived from data: 1) change in muscle activity; 2) increase in mobility; 3) decrease in pain; 4) increase in pressure pain threshold; 5) change in spinal tissue behavior; 6) change in the central nervous system or reflex pathways; and 7) correction of a vertebral dysfunction. CONCLUSIONS This scoping review identified 7 themes put forward by authors to explain changes in spinal stiffness following SMT. Unfortunately, none of the studies provided data which would support the promotion of one theme over another. As a result, this review suggests a need to develop a theoretical framework to explain rapid biomechanical changes following SMT to guide and prioritize future investigations in this important clinical area.
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Affiliation(s)
- Peter Jun
- Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 Street NW, Edmonton, Alberta, T6G 2G4, Canada
| | - Isabelle Pagé
- Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 Street NW, Edmonton, Alberta, T6G 2G4, Canada
| | - Albert Vette
- Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, 9211-116 Street, Edmonton, Alberta, T6G 1H9, Canada
| | - Greg Kawchuk
- Department of Physical Therapy, University of Alberta, Corbett Hall, 8205 114 Street NW, Edmonton, Alberta, T6G 2G4, Canada.
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Vining RD, Minkalis AL, Shannon ZK, Twist EJ. Development of an Evidence-Based Practical Diagnostic Checklist and Corresponding Clinical Exam for Low Back Pain. J Manipulative Physiol Ther 2019; 42:665-676. [PMID: 31864770 DOI: 10.1016/j.jmpt.2019.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/05/2019] [Accepted: 08/08/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study was to use scientific evidence to develop a practical diagnostic checklist and corresponding clinical exam for patients presenting with low back pain (LBP). METHODS An iterative process was conducted to develop a diagnostic checklist and clinical exam for LBP using evidence-based diagnostic criteria. The checklist and exam were informed by a systematic review focused on summarizing current research evidence for office-based clinical evaluation of common conditions causing LBP. RESULTS Diagnostic categories contained within the checklist and exam include nociceptive pain, neuropathic pain, and sensitization. Nociceptive pain subcategories include discogenic, myofascial, sacroiliac, and zygapophyseal (facet) joint pain. Neuropathic pain categories include neurogenic claudication, radicular pain, radiculopathy, and peripheral entrapment (piriformis and thoracolumbar syndrome). Sensitization contains 2 subtypes, central and peripheral sensitization. The diagnostic checklist contains individual diagnostic categories containing evidence-based criteria, applicable examination procedures, and checkboxes to record clinical findings. The checklist organizes and displays evidence for or against a working diagnosis. The checklist may help to ensure needed information is obtained from a patient interview and exam in a variety of primary spine care settings (eg, medical, chiropractic). CONCLUSION The available evidence informs reasonable working diagnoses for many conditions causing or contributing to LBP. A practical diagnostic process including an exam and checklist is offered to guide clinical evaluation and demonstrate evidence for working diagnoses in clinical settings.
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Affiliation(s)
- Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa.
| | - Amy L Minkalis
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Zacariah K Shannon
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Elissa J Twist
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
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