Pilot study of the impact sacroiliac joint manipulation has on walking kinematics using motion analysis technology

Effect of manual manipulation on mechanical gait parameters

CONTEXT

A variety of manual manipulation techniques are utilized in clinical practice to alleviate pain and improve musculoskeletal function. Many manual practitioners analyze gait patterns and asymmetries in their assessment of the patient, and an increasing number of gait motion capture studies are taking place with recent improvements in motion capture technology. This study is the first systematic review of whether these manual modalities have been shown to produce an objectively measurable change in gait mechanics.

OBJECTIVES

This study was designed to perform a systematic review of the literature to assess the impact of manual medicine modalities on biomechanical parameters of gait.

METHODS

A master search term composed of keywords and Medical Subject Headings (MeSH) search terms from an initial scan of relevant articles was utilized to search six databases. We screened the titles and abstracts of the resulting papers for relevance and then assessed their quality with the Cochrane Risk of Bias Tool. Clinical trials that featured both a manual manipulation intervention and multiple mechanical gait parameters were included. Case reports and other studies that only measured gait speed or other subjective measures of mobility were excluded.

RESULTS

We included 20 studies in our final analysis. They utilize manipulation techniques primarily from osteopathic, chiropractic, massage, and physiotherapy backgrounds. The conditions studied primarily included problems with the back, knee, and ankle, as well as healthy patients and Parkinson's patients. Control groups were highly variable, if not absent. Most studies measured their gait parameters utilizing either multicamera motion capture systems or force platforms.

CONCLUSIONS

Twelve of 20 papers included in the final analysis demonstrated a significant effect of manipulation on gait variables, many of which included either step length, walking speed, or sagittal range of motion (ROM) in joints of the lower extremity. However, the results and study design are too heterogeneous to draw robust conclusions from these studies as a whole. While there are initial indications that certain modalities may yield a change in certain gait parameters, the quality of evidence is low and there is insufficient evidence to conclude that manual therapies induce changes in biomechanical gait parameters. Studies are heterogeneous with respect to the populations studied and the interventions performed. Comparators were variable or absent across the studies, as were the outcome variables measured. More could be learned in the future with consistent methodology around blinding and sham treatment, and if the gait parameters measured were standardized and of a more robust clinical significance.

Reliability and Validity of the Variability Model Testing Procedure for Somatic Dysfunction Assessment: A Comparison with Gait Analysis Parameters in Healthy Subjects

Somatic dysfunction (SD) is an altered body function involving the musculoskeletal system. However, its clinical signs-tissue texture abnormalities, positional asymmetry, restricted range of motion, and tissue tenderness-did not achieve satisfactory results for reliability. A recent theoretical model proposed a revision assessing the movement variability around the joint rest position. The asymmetry and restriction of motion may characterize functional assessment in osteopathic clinical practice, demonstrating the reliability required. Hence, this study investigated the reliability of the new variability model (VM) with gait analysis (GA). Three blind examiners tested 27 young healthy subjects for asymmetry of motion around rest position and the SD grade on six body regions. The results were compared to the VICON procedure for 3D-GA. The inter-rater agreement for the detection of reduced movement variability ranged from 0.78 to 0.54, whereas for SD, grade ranged from 0.64 to 0.47. VM had a sensitivity and specificity of 0.62 and 0.53, respectively, in SD detection compared to step length normality. Global severity grade of SD demonstrated moderate to good correlation with spatial-temporal parameters. The VM showed palpatory reliability and validity with spatial-temporal parameters in GA. Those findings contribute to the innovation for SD examination with implications for the clinical practice.

A systematic review of chiropractic care for fall prevention: rationale, state of the evidence, and recommendations for future research

BACKGROUND

Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date. BODY: Systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, PEDro, and Index of Chiropractic Literature. Eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. Risk of bias was also assessed using the 8-item Cochrane Collaboration Tool. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis.

CONCLUSION

Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.

Effect of osteopathic manipulation on gait asymmetry

CONTEXT

Movement and loading asymmetry are associated with an increased risk of musculoskeletal injury, disease progression, and suboptimal recovery. Osteopathic structural screening can be utilized to determine areas of somatic dysfunction that could contribute to movement and loading asymmetry. Osteopathic manipulation treatments (OMTs) targeting identified somatic dysfunctions can correct structural asymmetries and malalignment, restoring the ability for proper compensation of stresses throughout the body. Little is currently known about the ability for OMTs to reduce gait asymmetries, thereby reducing the risk of injury, accelerated disease progression, and suboptimal recovery.

OBJECTIVES

To demonstrate whether osteopathic screening and treatment could alter movement and loading asymmetry during treadmill walking.

METHODS

Forty-two healthy adults (20 males, 22 females) between the ages of 18 and 35 were recruited for this prospective intervention. Standardized osteopathic screening exams were completed by a single physician for each participant, and osteopathic manipulation was performed targeting somatic dysfunctions identified in the screening exam. Three-dimensional (3-D) biomechanical assessments, including the collection of motion capture and force plate data, were performed prior to and following osteopathic manipulation to quantify gait mechanics. Motion capture and loading data were processed utilizing Qualisys Track Manager and Visual 3D software, respectively. Asymmetry in the following temporal, kinetic, and kinematic measures was quantified utilizing a limb symmetry index (LSI): peak vertical ground reaction force, the impulse of the vertical ground reaction force, peak knee flexion angle, step length, stride length, and stance time. A 2-way repeated-measures analysis of variance model was utilized to evaluate the effects of time (pre/post manipulation) and sex (male/female) on each measure of gait asymmetry.

RESULTS

Gait asymmetry in the peak vertical ground reaction force (-0.6%, p=0.025) and the impulse of the vertical ground reaction force (-0.3%, p=0.026) was reduced in males following osteopathic manipulation. There was no difference in gait asymmetry between time points in females. Osteopathic manipulation did not impact asymmetry in peak knee flexion angle, step length, stride length, or stance time. Among the participants, 59.5% (25) followed the common compensatory pattern, whereas 40.5% (17) followed the uncommon compensatory pattern. One third (33.3%, 14) of the participants showed decompensation at the occipitoatlantal (OA) junction, whereas 26.2% (11), one third (33.3%, 14), and 26.2% (11) showed decompensation at the cervicothoracic (CT), thoracolumbar (TL), and lumbosacral (LS) junctions, respectively. Somatic dysfunction at the sacrum, L5, right innominate, and left innominate occurred in 88.1% (37), 69.0% (29), 97.6% (41), and 97.6% (41) of the participants, respectively.

CONCLUSIONS

Correcting somatic dysfunction can influence gait asymmetry in males; the sex-specificity of the observed effects of osteopathic manipulation on gait asymmetry is worthy of further investigation. Osteopathic structural examinations and treatment of somatic dysfunctions may improve gait symmetry even in asymptomatic individuals. These findings encourage larger-scale investigations on the use of OMT to optimize gait, prevent injury and the progression of disease, and aid in recovery after surgery.