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Song YP, Liu JL, Zong CZ, Zhang FS, Ren YF, Ching YL, Wang YX, Li WX, Zhao H, Huang YR, Gao K. A bibliometric study on trends in chiropractic research from 1920 to 2023. Complement Ther Med 2024; 82:103038. [PMID: 38582375 DOI: 10.1016/j.ctim.2024.103038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE An increasing body of evidence suggests a positive role of chiropractic in the treatment of neuro-musculoskeletal disorders. This study aims to explore current research hotspots and trends, providing insights into the broad prospects of this field. METHODS A bibliometric review was conducted on all chiropractic articles included in the Web of Science Core Collection before December 31, 2023. RESULTS Over the past century, the volume of research in the field of chiropractic has been fluctuating annually, with four peaks observed in total. The United States, Canada, Australia, and the United Kingdom are leading countries. Chu, Eric Chun-Pu is the author with the most publications, while Bronfort, Gert has the highest total citation count. The University of Southern Denmark has produced the most publications, while Queens University - Canada is the most central institution. The Journal of Manipulative and Physiological Therapeutics is the journal with the most publications and citations, while the Journal of the American Medical Association is the most central journal. The two most-cited articles were both authored by Eisenberg DM. Emerging keywords include "chronic pain" and "skills". The theoretical mechanisms and scientific basis of chiropractic, its clinical practice and safety, education and training, integration with other disciplines, and patient experiences and satisfaction are the frontiers and hotspots of research. CONCLUSION This study integrates bibliometric analysis to summarize the current state of research and global network centers in the field of chiropractic, further highlighting the hotspots and trends in this field. However, Individual and national rankings should be interpreted with caution due to our focus on Web of Science rather than PubMed.
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Affiliation(s)
- Yi-Ping Song
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jia-Li Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chen-Zhong Zong
- The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fang-Shuo Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yan-Feng Ren
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yuen-Lim Ching
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yi-Xiao Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Wen-Xun Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - He Zhao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Yi-Ran Huang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.
| | - Kuo Gao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
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Kerry R, Young KJ, Evans DW, Lee E, Georgopoulos V, Meakins A, McCarthy C, Cook C, Ridehalgh C, Vogel S, Banton A, Bergström C, Mazzieri AM, Mourad F, Hutting N. A modern way to teach and practice manual therapy. Chiropr Man Therap 2024; 32:17. [PMID: 38773515 PMCID: PMC11110311 DOI: 10.1186/s12998-024-00537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/17/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. PURPOSE The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. METHODS A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. CONCLUSIONS Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.
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Affiliation(s)
- Roger Kerry
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
| | - Kenneth J Young
- Allied Health Research Unit, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - David W Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Edward Lee
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- Nottingham CityCare Partnership, Bennerley Rd, Nottingham, NG6 8WR, UK
| | - Vasileios Georgopoulos
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2HA, UK
| | - Adam Meakins
- Department of Orthopaedics, West Herts Hospitals Trust, Watford, WD18 0HB, UK
| | - Chris McCarthy
- School of Physiotherapy, Manchester Metropolitan University, Manchester, M15 6GX, UK
| | - Chad Cook
- Department of Orthopaedics, Duke University, 200 Morris Street, Durham, NC, 27701, USA
| | - Colette Ridehalgh
- School of Sport and Health Sciences, University of Brighton, Darley Rd, Eastbourne, BN20 7UR, UK
- Clinical Neuroscience, Trafford Building, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Steven Vogel
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Amanda Banton
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187, Umeå, Sweden
| | | | - Firas Mourad
- Department of health, LUNEX, Differdange, 4671, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, Differdange, 4671, Luxembourg
| | - Nathan Hutting
- Department of Occupation and Health, School of Organization and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Choi G, Giuliano D, Tibbles A, Howarth SJ, Tran S, Lee J, Funabashi M. Investigating force-time characteristics of prone thoracic SMT and self-reported patient outcome measures: a feasibility study. Chiropr Man Therap 2023; 31:19. [PMID: 37420257 DOI: 10.1186/s12998-023-00491-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/13/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) is commonly used to treat musculoskeletal conditions, including thoracic spine pain. Applying patient-specific force-time characteristics are believed to be important to improve SMT's effectiveness. Investigating SMT as part of a multimodal approach is fundamental to account for the complexity of chiropractic clinical practice. Therefore, pragmatic investigations balancing minimal disruptions to the clinical encounter at the same time as ensuring a robust data quality with rigorous protocols are needed. Consequently, preliminary studies are required to assess the study protocol, quality of data recorded and the sustainability of such investigation. Therefore, this study examined the feasibility of investigating SMT force-time characteristics and clinical outcome measures in a clinical setting. METHODS In this mixed-methods study, providers recorded thoracic SMT force-time characteristics delivered to patients with thoracic spinal pain during regular clinical encounters. Self-reported clinical outcomes of pain, stiffness, comfort during the SMT (using an electronic visual analogue scale), and global rating of change scale were measured before and after each SMT application. Feasibility was quantitatively assessed for participant recruitment, data collection and data quality. Qualitative data assessed participants' perceptions on the impact of data collection on patient management and clinical flow. RESULTS Twelve providers (58% female, 27.3 ± 5.0 years old) and twelve patients (58% female, 37.2 ± 14.0 years old) participated in the study. Enrolment rate was greater than 40%, data collection rate was 49% and erroneous data was less than 5%. Participant acceptance was good with both providers and patients reporting positive experience with the study. CONCLUSIONS Recording SMT force-time characteristics and self-reported clinical outcome measures during a clinical encounter may be feasible with specific modification to the current protocol. The study protocol did not negatively impact patient management. Specific strategies to optimize the data collection protocol for the development of a large clinical database are being developed.
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Affiliation(s)
- Grand Choi
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Dominic Giuliano
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Anthony Tibbles
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Samuel J Howarth
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Steve Tran
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Joyce Lee
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Martha Funabashi
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada.
- Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, QC, G9A 5H7, Canada.
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Robert Gunzburg and Marek Szpalski: 2022 ISSLS Wiltse Lifetime Achievement Award. Spine (Phila Pa 1976) 2022. [PMID: 35471967 DOI: 10.1097/brs.0000000000004352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Evaluation and Treatment of Trigeminal Symptoms of Cervical Origin After a Motor-Vehicle Crash: A Case Report With 9-Month Follow-up. J Chiropr Med 2022; 21:51-59. [PMID: 35747612 DOI: 10.1016/j.jcm.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this case report is to describe the management of a patient with trigeminal symptoms of cervical origin after a motor-vehicle crash (MVC). Clinical Features After a head-on MVC, a 65-year-old woman presented with complaints of dizziness, headaches, facial tingling, visual disturbance, tinnitus, loss of cervical motion, and pain in the cervical spine. Intervention and Outcome The intervention applied was manipulation of the left C1-C2 and right C2-C3, with targeted exercise to strengthen the cervical musculature. After 4 weeks of treatment, the patient reported improvement in functional tasks and reduction in overall pain, headaches, facial tingling, tinnitus, and dizziness. At a 9-month follow-up, the patient had no report of facial tingling, tinnitus, loss of motion, or eye pain. Conclusion This patient with trigeminal symptoms of cervical origin after an MVC responded well to manual therapy to the cervical spine as part of a combination of services.
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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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Effects of biomechanical parameters of spinal manipulation: A critical literature review. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2021; 20:4-12. [PMID: 34756673 DOI: 10.1016/j.joim.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022]
Abstract
Spinal manipulation is a manual treatment technique that delivers a thrust, using specific biomechanical parameters to exert its therapeutic effects. These parameters have been shown to have a unique dose-response relationship with the physiological responses of the therapy. So far, however, there has not been a unified approach to standardize these biomechanical characteristics. In fact, it is still undetermined how they affect the observed clinical outcomes of spinal manipulation. This study, therefore, reviewed the current body of literature to explore these dosage parameters and evaluate their significance, with respect to physiological and clinical outcomes. From the experimental studies reviewed herein, it is evident that the modulation of manipulation's biomechanical parameters elicits transient physiological responses, including changes in neuronal activity, electromyographic responses, spinal stiffness, muscle spindle responses, paraspinal muscle activity, vertebral displacement, and segmental and intersegmental acceleration responses. However, to date, there have been few clinical trials that tested the therapeutic relevance of these changes. In addition, there were some inherent limitations in both human and animal models due to the use of mechanical devices to apply the thrust. Future studies evaluating the effects of varying biomechanical parameters of spinal manipulation should include clinicians to deliver the therapy in order to explore the true clinical significance of the dose-response relationship.
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Butts R, Legaspi O, Nocera-Mekel A, Dunning J. Physical therapy treatment of a pediatric patient with symptoms consistent with a spinal cord injury without radiographic abnormality: A retrospective case report. J Bodyw Mov Ther 2021; 27:455-463. [PMID: 34391271 DOI: 10.1016/j.jbmt.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND A spinal cord injury without radiographic abnormality (SCIWORA) is a relatively uncommon event that occurs in children following cervical trauma primarily due to sports-related injuries or physical abuse. CASE DESCRIPTION This case report describes an 11-year-old wrestler that developed signs and symptoms consistent with a SCIWORA following neck trauma during competition. Despite all diagnostic tests being inconclusive, the patient demonstrated increased cervical, thoracic, and lumbar paraspinal tone along with pain, loss of sensation, loss of mobility, and weakness of the lower extremities. As a result, the patient was confined to a wheelchair and required maximum assistance to transfer and ambulate with a walker. The patient was referred to physical therapy nine days after the traumatic event, where he received interferential current with moist heat, myofascial release of paraspinal muscles, functional exercise, gait training, and spinal manipulative therapy targeting the cervical, thoracic, and lumbar vertebrae. OUTCOME After 13 physical therapy treatments over 5-weeks, the patient was able to ambulate independently and perform all activities of daily living without pain or functional limitation. The following case report outlines this patient's successful journey toward recovery. CONCLUSION This case report suggests that spinal manipulative therapy may be a safe and effective intervention when used within a multi-modal treatment strategy for patients with signs and symptoms consistent with SCIWORA. Moreover, spinal manipulative therapy may be considered a beneficial treatment in some pediatric patients. However, this report describes a single patient, and further research is required on the use of spinal manipulation in this patient population.
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Affiliation(s)
- Raymond Butts
- Research Physical Therapy Specialists, Columbia, SC, USA; American Academy of Manipulative Therapy, Montgomery, AL, USA.
| | | | | | - James Dunning
- American Academy of Manipulative Therapy, Montgomery, AL, USA; Montgomery Osteopractic Physiotherapy and Acupuncture Clinic, Montgomery, AL, USA
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Mikhail J, Funabashi M, Descarreaux M, Pagé I. Assessing forces during spinal manipulation and mobilization: factors influencing the difference between forces at the patient-table and clinician-patient interfaces. Chiropr Man Therap 2020; 28:57. [PMID: 33168008 PMCID: PMC7654015 DOI: 10.1186/s12998-020-00346-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/19/2020] [Indexed: 01/16/2023] Open
Abstract
Background Spinal manipulative therapy (SMT) and mobilization (MOB) effects are believed to be related to their force characteristics. Most previous studies have either measured the force at the patient-table interface or at the clinician-patient interface. The objectives of this study were to determine 1) the difference between the force measured at the patient-table interface and the force applied at the clinician-patient interface during thoracic SMT and MOB, and 2) the influence of the SMT/MOB characteristics, participants’ anthropometry and muscle activity (sEMG) on this difference. Methods An apparatus using a servo-linear motor executed 8 SMT/MOB at the T7 vertebrae in 34 healthy adults between May and June 2019. SMT and MOB were characterized by a 20 N preload, total peak forces of 100 N or 200 N, and thrust durations of 100 ms, 250 ms, 1 s or 2 s. During each trial, thoracic sEMG, apparatus displacement as well as forces at the patient-table interface and the clinician-patient interface were recorded. The difference between the force at both interfaces was calculated. The effect of SMT/MOB characteristics on the difference between forces at both interfaces and correlations between this difference and potential influencing factors were evaluated. Results Force magnitudes at the patient-table interface were, in most trials, greater than the force at the clinician-patient interface (up to 135 N). SMT/MOB characteristics (total peak force, thrust duration and rate of force application) affected the difference between forces at both interfaces (all p-values< 0.05). No factor showed significant correlations with the difference between forces at both interfaces for the 8 SMT/MOB. Conclusions The results revealed that the force measured at the patient-table interface is greater than the applied force at the clinician-patient interface during thoracic SMT and MOB. By which mechanism the force is amplified is not yet fully understood.
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Affiliation(s)
- Jérémie Mikhail
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 boul. Des Forges, Trois-Rivières, G8Z 4M3, Québec, Canada
| | - Martha Funabashi
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 boul. Des Forges, Trois-Rivières, G8Z 4M3, Québec, Canada.,Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 boul. Des Forges, Trois-Rivières, G8Z 4M3, Québec, Canada
| | - Isabelle Pagé
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 boul. Des Forges, Trois-Rivières, G8Z 4M3, Québec, Canada. .,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 25 Wilfrid-Hamel Blvd., Québec, G1M 2S8, Québec, Canada.
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Paredes R, Crasto C, Magalhães B, Carvalho P. Short-Term Effects of Global Pelvic Manipulation on Knee Joint Position Sense in Asymptomatic Participants: A Double-Blind Randomized Controlled Trial. J Manipulative Physiol Ther 2020; 43:675-682. [PMID: 32863057 DOI: 10.1016/j.jmpt.2018.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 08/08/2018] [Accepted: 11/28/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate short-term effects of the global pelvic manipulation (GPM) on knee joint position sense (JPS). METHODS This randomized, controlled double-blind trial included 26 asymptomatic participants (X¯± 25.3; standard deviation ± 4.4 years) who were randomly allocated into 2 groups. Sixteen participants were allocated into the experimental group, in which GPM was performed, and the rest of the participants (n = 10) were included in the control group, which received sham ultrasound therapy. Each participant attended 1 session only, and the evaluations were assessed pretreatment and 5 minutes posttreatment through an isokinetic dynamometer (Biodex Medical Systems), in which the data regarding knee JPS ipsilateral to the manipulated sacroiliac joint were collected. Mann-Whitney and Wilcoxon tests were used, with a 95% significance level. RESULTS There were no statistically significant differences between the groups concerning active and passive JPS at 30° and 60° (P > .05). The results showed a lack of significant differences between the moments in both groups (P > .05). CONCLUSION This investigation demonstrated that GPM, with high-velocity low-amplitude thrust, has no effect on knee JPS, suggesting that this manipulative technique does not have a relative effect on muscle spindles and Golgi tendon organ activation in asymptomatic participants.
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Affiliation(s)
- Ricardo Paredes
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal.
| | - Carlos Crasto
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal
| | - Barbara Magalhães
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal
| | - Paulo Carvalho
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal
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Gyer G, Michael J, Inklebarger J, Tedla JS. Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2019; 17:328-337. [DOI: 10.1016/j.joim.2019.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/22/2019] [Indexed: 12/19/2022]
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Pasquier M, Daneau C, Marchand AA, Lardon A, Descarreaux M. Spinal manipulation frequency and dosage effects on clinical and physiological outcomes: a scoping review. Chiropr Man Therap 2019; 27:23. [PMID: 31139346 PMCID: PMC6530068 DOI: 10.1186/s12998-019-0244-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/13/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction The burden of musculoskeletal disorders increases every year, with low back and neck pain being the most frequently reported conditions for seeking manual therapy treatment. In recent years, manual therapy research has begun exploring the dose-response relationship between spinal manipulation treatment characteristics and both clinical and physiological response to treatment. Objective The purpose of this scoping review was to identify and appraise the current state of scientific knowledge regarding the effects of spinal manipulation frequency and dosage on both clinical and physiological responses. Methods A scoping review was conducted to identify all available studies pertaining to our research question. Retrieved papers were screened using a 2-phase method, a selective sorting with titles and abstracts. Potentially relevant studies were read, and data was extracted for all included studies. Randomized control trials were assessed using the Cochrane Risk of Bias Tool for quality assessment. Results The search yielded 4854 publications from which 32 were included for analysis. Results were sorted by dosage or frequency outcomes, and divided into human or animal studies. Animal studies mainly focused on dosage and evaluated physiological outcomes only. Studies investigating spinal manipulation dosage effects involved both human and animal research, and showed that varying thrust forces, or thrust durations can impact vertebral displacement, muscular response amplitude or muscle spindle activity. Risk of bias analysis indicated only two clinical trials assessing frequency effects presented a low risk of bias. Although trends in improvement were observed and indicated that increasing the number of SM visits in a short period of time (few weeks) decreased pain and improve disability, the differences between the studied treatment frequencies, were often not statistically significant and therefore not clinically meaningful. Conclusion The results of this study showed that SM dosage and frequency effects have been mostly studied over the past two decades. Definitions for these two concepts however differ across studies. Overall, the results showed that treatment frequency does not significantly affect clinical outcomes during and following a SM treatment period. Dosage effects clearly influence short-term physiological responses to SM treatment, but relationships between these responses and clinical outcomes remains to be investigated.
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Affiliation(s)
- Mégane Pasquier
- 1Department of Anatomy, Université du Québec à Trois-Rivières, Trois- Rivières, Québec Canada.,Institut Franco-Européen de Chiropraxie, Ivry-sur-Seine, France
| | - Catherine Daneau
- 3Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois- Rivières, Québec Canada
| | - Andrée-Anne Marchand
- 1Department of Anatomy, Université du Québec à Trois-Rivières, Trois- Rivières, Québec Canada
| | - Arnaud Lardon
- Institut Franco-Européen de Chiropraxie, Ivry-sur-Seine, France.,4CIAMS, Université Paris-Sud, Université Paris-Saclay, Orsay, France.,5CIAMS, Université d'Orléans, Orléans, France
| | - Martin Descarreaux
- 3Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois- Rivières, Québec Canada
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Sueki D, Almaria S, Bender M, McConnell B. The immediate and 1-week effects of mid-thoracic thrust manipulation on lower extremity passive range of motion. Physiother Theory Pract 2018; 36:720-730. [PMID: 30015546 DOI: 10.1080/09593985.2018.1492056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Research suggests that spinal manipulation may effect motion. Less clear is whether this effect is limited to localized responses or may involve generalizable changes. Objective: To determine whether Mid-thoracic manipulation (MTM) would result in a significant change in the lower extremity passive straight leg raise (PSLR) range of motion immediately and after 1 week. Methods: Twenty-three healthy subjects were randomly assigned in a double-blinded study. An experimental group received MTM and a control group received a sham intervention. PSLR measurements were taken prior to, immediately after, and one week after the intervention. Results: Mixed model repeated measure analysis of variance was used to determine that there was a significant interaction between MTM and time (F(2, 21) = 3.84, p < 0.05). Post hoc tests revealed a significant difference between the pretest to immediate posttest values (p < 0.05, SE = 1.47). PSLR in the MTM group increased 10.3° while the sham group increased 1.9°. Difference was non-significant between pretest and 1-week follow-up (p = 0.129, SE = 2.46). Conclusions: MTM may immediately increase lower extremity passive range of motion, but the effect was lost by the 1-week follow-up. This supports evolving research suggesting that spinal manipulation may have a generalized but transient physiological effect.
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Affiliation(s)
- Derrick Sueki
- Department of Physical Therapy, Azusa Pacific University , Azusa, CA, USA
| | - Shaun Almaria
- Peak Sports Medicine and Rehabilitation , Phoenix, AZ, USA
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Butts R, Dunning J, Pavkovich R, Mettille J, Mourad F. Conservative management of temporomandibular dysfunction: A literature review with implications for clinical practice guidelines (Narrative review part 2). J Bodyw Mov Ther 2017; 21:541-548. [DOI: 10.1016/j.jbmt.2017.05.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/22/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
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Reed WR, Pickar JG, Sozio RS, Liebschner MAK, Little JW, Gudavalli MR. Characteristics of Paraspinal Muscle Spindle Response to Mechanically Assisted Spinal Manipulation: A Preliminary Report. J Manipulative Physiol Ther 2017. [PMID: 28633885 DOI: 10.1016/j.jmpt.2017.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this preliminary study is to determine muscle spindle response characteristics related to the use of 2 solenoid powered clinical mechanically assisted manipulation (MAM) devices. METHODS L6 muscle spindle afferents with receptive fields in paraspinal muscles were isolated in 6 cats. Neural recordings were made during L7 MAM thrusts using the Activator V (Activator Methods Int. Ltd., Phoenix, AZ) and/or Pulstar (Sense Technology Inc., Pittsburgh, PA) devices at their 3 lowest force settings. Mechanically assisted manipulation response measures included (a) the time required post-thrust until the first action potential, (b) differences in mean frequency (MF) and mean instantaneous frequency (MIF) 2 seconds before and after MAM, and (c) the time required for muscle spindle discharge (MF and MIF) to return to 95% of baseline after MAM. RESULTS Depending on device setting, between 44% to 80% (Pulstar) and 11% to 63% (Activator V) of spindle afferents required >6 seconds to return to within 95% of baseline MF values; whereas 66% to 89% (Pulstar) and 75% to 100% (Activator V) of spindle responses returned to within 95% of baseline MIF in <6 seconds after MAM. Nonparametric comparisons between the 22 N and 44 N settings of the Pulstar yielded significant differences for the time required to return to baseline MF and MIF. CONCLUSION Short duration (<10 ms) MAM thrusts decrease muscle spindle discharge with a majority of afferents requiring prolonged periods (>6 seconds) to return to baseline MF activity. Physiological consequences and clinical relevance of described MAM mechanoreceptor responses will require additional investigation.
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Affiliation(s)
- William R Reed
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
| | - Joel G Pickar
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - Randall S Sozio
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - Michael A K Liebschner
- Department of Neurosurgery, Baylor College of Medicine, Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Joshua W Little
- Center for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO
| | - Maruti R Gudavalli
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
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Abstract
STUDY DESIGN Comparative study using robotic replication of spinal manipulative therapy (SMT) vertebral kinematics together with serial dissection. OBJECTIVE The aim of this study was to quantify loads created in cadaveric spinal tissues arising from three different forms of SMT application. SUMMARY OF BACKGROUND DATA There exist many distinct methods by which to apply SMT. It is not known presently whether different forms of SMT application have different effects on spinal tissues. Should the method of SMT application modulate spinal tissue loading, quantifying this relation may help explain the varied outcomes of SMT in terms of effect and safety. METHODS SMT was applied to the third lumbar vertebra in 12 porcine cadavers using three SMT techniques: a clinical device that applies forces through a hand-held instrument (INST), a manual technique of applying SMT clinically (MAN) and a research device that applies parameters of manual SMT through a servo-controlled linear actuator motor (SERVO). The resulting kinematics from each SMT application were tracked optically via indwelling bone pins. The L3/L4 segment was then removed, mounted in a parallel robot and the resulting kinematics from SMT replayed for each SMT application technique. Serial dissection of spinal structures was conducted to quantify loading characteristics of discrete spinal tissues. RESULTS In terms of load magnitude, SMT application with MAN and SERVO created greater forces than INST in all conditions (P < 0.05). Additionally, MAN and SERVO created comparable posterior forces in the intact specimen, but MAN created greater posterior forces on IVD structures compared to SERVO (P < 0.05). CONCLUSION Specific methods of SMT application create unique vertebral loading characteristics, which may help explain the varied outcomes of SMT in terms of effect and safety. LEVEL OF EVIDENCE N/A.
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Behrangrad S, Kamali F. Comparison of ischemic compression and lumbopelvic manipulation as trigger point therapy for patellofemoral pain syndrome in young adults: A double-blind randomized clinical trial. J Bodyw Mov Ther 2016; 21:554-564. [PMID: 28750964 DOI: 10.1016/j.jbmt.2016.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/26/2016] [Accepted: 08/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effectiveness of ischemic compression (IC) directly to the vastus medialis obliquus (VMO) versus lumbopelvic manipulation (LPM) in improving pain, functional status and sensitivity to mechanical stimulation of the VMO trigger point in patients with patellofemoral pain syndrome (PFPS). PARTICIPANTS 40 patients with unilateral PFPS aged 20-30 years were selected randomly among patients with unilateral PFPS referred to physical therapy clinics of Shiraz University of Medical Sciences in Shiraz, Iran, between March 2014 and July 2014. 30 young adults participated. Participants were blinded to treatment allocation, and 15 patients were allocated to either IC or LPM. INTERVENTIONS Patients in both groups were treated in three sessions per week. IC consisted of three sets of continuous pressure applied for on the myofascial trigger point (MTrP) of VMO. LPM consisted of supine rotational glide manipulation of the ipsilateral lumbopelvic region of the involved knee. MAIN OUTCOME MEASURES Numeric pain rating scale (VAS) for pain intensity, Kujala questionnaire for functional status, and pressure pain threshold (PPT) for sensitivity to mechanical stimulation. All three were recorded before treatment, 1 week, 1 month and 3 months after the last session. RESULTS Both groups showed significant improvement (p < 0.05, 95% confidence interval) in pain, functional status and PPT values. However, the IC group showed greater improvements, and outcome measures remained significantly better than in the LPM group during post-intervention follow-up. CONCLUSIONS Both groups showed improvements throughout the study and follow-up period. However, the IC showed better short-term and long-term effectiveness than LPM for treating PFPS.
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Affiliation(s)
- Shabnam Behrangrad
- Physiotherapy Department, School of Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ameloot B, Bagust J. The immediate effect of multiple mechanical impulses on electromyography and pressure pain threshold of lumbar latent trigger points: an experimental study. Chiropr Man Therap 2016; 24:20. [PMID: 27379178 PMCID: PMC4931704 DOI: 10.1186/s12998-016-0101-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/09/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Myofascial pain is a common syndrome, which has not been studied extensively in the low back. Despite a variety of manual and instrument assisted interventions available, little work has targeted the possible effects of fast mechanical impulses on myofascial trigger points (MTrPs) on its sensitivity and electrical activity. The purpose of this experimental study was to quantify the immediate effect of one session of mechanical impulses to lumbar latent MTrPs and to normal muscle tissue with pressure pain threshold (PPT) and surface electromyography (sEMG) as outcome measures. METHODS During the autumn of 2009, in 41 asymptomatic subjects between 17-40 years of age the lumbar musculature was searched for a latent MTrP by a trained clinician. Using 3 disposable pre-gelled electrodes bilaterally, sEMG was recorded continuously from muscle containing either latent or no MTrP. Both the trigger point group and control group received the intervention and were blinded to group allocation. The immediate effects of mechanical impulses were assessed by sEMG and PPT before and after intervention using Wilcoxon matched-pairs signed-ranks test, Mann-Whitney U test and paired t-tests. RESULTS The PPT increased significantly across both groups (p < 0.01) after intervention. The proportionate increase (14.6 %) was comparable in both MTrP and control groups. The electrical activity on the MTrP side was not significantly higher in the MTrP group compared to the contralateral side. The decrease of resting electrical activity after intervention was significant in the MTrP group on the side of the latent MTrP (P = 0.001) as well as the contralateral side (p=0.022), and not significant in the control group on either side (p=0.33 and p=0.93). CONCLUSION In this study, the immediate effect of one session of mechanical impulses was associated with a significant increase in PPT for both groups and a significant decrease in the resting electrical activity of the lumbar muscles only in the MTrP group. It is unknown if these effects have clinical significance.
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Affiliation(s)
- Bert Ameloot
- />Graaf van Landaststraat 17, 9700 Oudenaarde, Belgium
| | - Jeff Bagust
- />Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF Dorset UK
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Starmer DJ, Guist BP, Tuff TR, Warren SC, Williams MGR. Changes in Manipulative Peak Force Modulation and Time to Peak Thrust among First-Year Chiropractic Students Following a 12-Week Detraining Period. J Manipulative Physiol Ther 2016; 39:311-7. [PMID: 27059248 DOI: 10.1016/j.jmpt.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/05/2015] [Accepted: 09/18/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze differences in peak force modulation and time-to-peak thrust in posterior-to-anterior (PA) high-velocity-low-amplitude (HVLA) manipulations in first-year chiropractic students prior to and following a 12-week detraining period. METHODS Chiropractic students (n=125) performed 2 thrusts prior to and following a 12-week detraining period: total peak force targets were 400 and 600 N, on a force-sensing table using a PA hand contact of the participant's choice (bilateral hypothenar, bilateral thenar, or cross bilateral). Force modulation was compared to defined target total peak force values of 600 and 400 N, and time-to-peak thrust was compared between data sets using 2-tailed paired t-tests. RESULTS Total peak force for the 600 N intensity varied by 124.11 + 65.77 N during the pre-test and 123.29 + 61.43 N during the post-test compared to the defined target of 600 N (P = .90); total peak force for the 400 N intensity varied by 44.91 + 34.67 N during the pre-test and 44.60 + 32.63 N during the post-test compared to the defined target of 400 N (P = .57). Time-to-peak thrust for the 400 N total peak force was 137.094 + 42.47 milliseconds during the pre-test and 125.385 + 37.46 milliseconds during the post-test (P = .0004); time-to-peak thrust for the 600 N total peak force was 136.835 + 40.48 milliseconds during the pre-test and 125.385 + 33.78 milliseconds during the post-test (P = .03). CONCLUSIONS The results indicate no drop-off in the ability to modulate force for either thrust intensity, but did indicate a statistically significant change in time-to-peak thrust for the 400 N total peak force thrust intensity in first-year chiropractic students following a 12-week detraining period.
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Affiliation(s)
- David J Starmer
- Education Coordinator, Simulation Lab, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Chair, Faculty Council, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Brett P Guist
- Research Assistant, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | - Taylor R Tuff
- Sports Science Resident, Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Sarah C Warren
- Research Assistant, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Matthew G R Williams
- Research Assistant, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Research Assistant, University of New Brunswick, Fredericton, NB, Canada
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Consistency and Malleability of Manipulation Performance in Experienced Clinicians: A Pre-Post Experimental Design. J Manipulative Physiol Ther 2015. [DOI: 10.1016/j.jmpt.2015.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Edgecombe TL, Kawchuk GN, Long CR, Pickar JG. The effect of application site of spinal manipulative therapy (SMT) on spinal stiffness. Spine J 2015; 15:1332-8. [PMID: 24139864 PMCID: PMC3989461 DOI: 10.1016/j.spinee.2013.07.480] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 05/21/2013] [Accepted: 07/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Like other factors that can influence treatment efficacy (eg, dosage, frequency, time of day), the site of treatment application is known to affect various physical interventions such as topical anesthetics and cardiopulmonary resuscitation. Like these examples, spinal manipulative therapy (SMT) is a physical intervention that may exhibit maximal benefit when directed to a specific site. Whereas numerous studies of SMT efficacy have produced mixed results, few studies have taken into account the site of SMT application. PURPOSE To determine if the site of SMT application modulates the effect of SMT in an anesthetized feline model. STUDY DESIGN Spinal manipulative therapy applied to specific anatomic locations randomized in a Latin square design with a no-SMT control. OUTCOME MEASURES Physiologic measures (spinal stiffness). METHODS Simulated SMT was delivered by a validated mechanical apparatus to the intact lumbar spine of eight anesthetized felines at four unique sites: L6 spinous process, left L6 lamina, left L6 mammillary process, and L7 spinous process. To measure spinal stiffness, a separate indentation load was applied mechanically to the L6 spinous process before and after each SMT application. Spinal stiffness was calculated from the resulting force-displacement curve as the average stiffness (k) and terminal instantaneous stiffness (TIS). RESULTS Relative to the no-SMT control, significant decreases in spinal stiffness followed the SMT when L6 spinous and L6 lamina were used as the contact site. Terminal instantaneous stiffness significantly decreased -0.48 N/mm (upper, lower 95% confidence interval [-0.86, -0.09]) with L6 spinous as the contact site and decreased -0.44 N/mm (-0.82, -0.05), with the L6 lamina as the contact site. k increased 0.44 N/mm (-0.01, 088), using L6 spinous as the contact site. CONCLUSIONS Decreases in terminal spinal stiffness were observed after SMT delivered at some application sites but not the others. The results suggest that SMT contact site modulates SMT's effect on spinal stiffness in a feline model. Changes in spinal terminal instantaneous spinal stiffness were similar in magnitude and direction to those observed in symptomatic human subjects who report benefits after SMT.
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Affiliation(s)
- Tiffany L Edgecombe
- Department of Physical Therapy, University of Alberta, 8205 114 St, Corbett Hall, Edmonton, AB, Canada T6G 2G4
| | - Greg N Kawchuk
- Department of Physical Therapy, University of Alberta, 8205 114 St, Corbett Hall, Edmonton, AB, Canada T6G 2G4.
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, 1000 N Brady St, Davenport, Iowa 52803, USA
| | - Joel G Pickar
- Palmer Center for Chiropractic Research, 1000 N Brady St, Davenport, Iowa 52803, USA
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Reed WR, Liebschner MAK, Sozio RS, Pickar JG, Gudavalli MR. Neural Response During a Mechanically Assisted Spinal Manipulation in an Animal Model: A Pilot Study. ACTA ACUST UNITED AC 2015; 2:20-27. [PMID: 26618202 PMCID: PMC4659401 DOI: 10.17352/2455-5487.000021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction Mechanoreceptor stimulation is theorized to contribute to the therapeutic efficacy of spinal manipulation. Use of mechanically-assisted spinal manipulation (MA-SM) devices is increasing among manual therapy clinicians worldwide. The purpose of this pilot study is to determine the feasibility of recording in vivo muscle spindle responses during a MA-SM in an intervertebral fixated animal model. Methods Intervertebral fixation was created by inserting facet screws through the left L5-6 and L6-7 facet joints of a cat spine. Three L6muscle spindle afferents with receptive fields in back muscles were isolated. Recordings were made during MA-SM thrusts delivered to the L7 spinous process using an instrumented Activator IV clinical device. Results Nine MA-SM thrusts were delivered with peak forces ranging from 68-122N and with thrust durations of less than 5ms. High frequency muscle spindle discharge occurred during MA-SM. Following the MA-SM, muscle spindle responses included returning to pre-manipulation levels, slightly decreasing for a short window of time, and greatly decreasing for more than 40s. Conclusion This study demonstrates that recording in vivo muscle spindle response using clinical MA-SM devices in an animal model is feasible. Extremely short duration MA-SM thrusts (<5ms) can have an immediate and/or a prolonged (> 40s) effect on muscle spindle discharge. Greater peak forces during MA-SM thrusts may not necessarily yield greater muscle spindle responses. Determining peripheral response during and following spinal manipulation may be an important step in optimizing its’ clinical efficacy. Future studies may investigate the effect of thrust dosage and magnitude.
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Affiliation(s)
- William R Reed
- Palmer Center for Chiropractic Research, Davenport, IA, USA
| | | | - Randall S Sozio
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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Acceleration of clinician hand movements during spinal manipulative therapy. MANUAL THERAPY 2014; 20:342-8. [PMID: 25458144 DOI: 10.1016/j.math.2014.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 10/01/2014] [Accepted: 10/16/2014] [Indexed: 11/20/2022]
Abstract
This study used an observational design to examine the kinematics of spinal manipulative therapy (SMT) by determining the acceleration characteristics of the manipulative input at the cervical, thoracic, and lumbar spinal regions. Studies of SMT have been restricted to measuring the forces that result from the manipulative input. Several studies have indicated the rate of force development is a key parameter of clinically delivered SMT. Despite this, the movement strategies employed during SMT, including acceleration, have not been directly measured. Participants (n = 29) were recruited from a private practice chiropractic clinic. A wireless accelerometer attached to the clinician's hand was used to characterize the thrust phase of the SMT treatments. Significant differences were found across each spinal region for acceleration amplitude parameters (p < 0.0001). Post-hoc analysis indicated that amplitudes significantly increased in order from thoracic to cervical to lumbar regions (p < 0.0001). Spinal level was also a significant factor in determining the temporal parameters of hand acceleration during SMT (p < 0.0005). This study provides a description of the acceleration properties of clinically delivered SMT. Consistent with that reported for SMT forces, acceleration amplitudes varied significantly across spinal regions with relatively little differences in acceleration latencies. Notably, acceleration amplitudes and latencies were not associated with each other within spinal regions. These findings indicate that changes in acceleration amplitude, rather than latency, are used to tailor SMT to individuals.
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Short-term effect of spinal manipulation on pain perception, spinal mobility, and full height recovery in male subjects with degenerative disk disease: a randomized controlled trial. Arch Phys Med Rehabil 2014; 95:1613-9. [PMID: 24862763 DOI: 10.1016/j.apmr.2014.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 04/15/2014] [Accepted: 05/01/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the short-term effect on spinal mobility, pain perception, neural mechanosensitivity, and full height recovery after high-velocity, low-amplitude (HVLA) spinal manipulation (SM) in the lumbosacral joint (L5-S1). DESIGN Randomized, double-blind, controlled clinical trial with evaluations at baseline and after intervention. SETTING University-based physical therapy research clinic. PARTICIPANTS Men (N=40; mean age ± SD, 38 ± 9.14 y) with diagnosed degenerative lumbar disease at L5-S1 were randomly divided into 2 groups: a treatment group (TG) (n=20; mean age ± SD, 39 ± 9.12 y) and a control group (CG) (n=20; mean age ± SD, 37 ± 9.31 y). All participants completed the intervention and follow-up evaluations. INTERVENTIONS A single L5-S1 SM technique (pull-move) was performed in the TG, whereas the CG received a single placebo intervention. MAIN OUTCOME MEASURES Measures included assessing the subject's height using a stadiometer. The secondary outcome measures included perceived low back pain, evaluated using a visual analog scale; neural mechanosensitivity, as assessed using the passive straight-leg raise (SLR) test; and amount of spinal mobility in flexion, as measured using the finger-to-floor distance (FFD) test. RESULTS The intragroup comparison indicated a significant improvement in all variables in the TG (P<.001). There were no changes in the CG, except for the FFD test (P=.008). In the between-group comparison of the mean differences from pre- to postintervention, there was statistical significance for all cases (P<.001). CONCLUSIONS An HVLA SM in the lumbosacral joint performed on men with degenerative disk disease immediately improves self-perceived pain, spinal mobility in flexion, hip flexion during the passive SLR test, and subjects' full height. Future studies should include women and should evaluate the long-term results.
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Duarte FCK, Kolberg C, Barros RR, Silva VGA, Gehlen G, Vassoler JM, Partata WA. Evaluation of peak force of a manually operated chiropractic adjusting instrument with an adapter for use in animals. J Manipulative Physiol Ther 2014; 37:236-41. [PMID: 24793371 DOI: 10.1016/j.jmpt.2014.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 01/20/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study was designed to assess the peak force of a manually operated chiropractic adjusting instrument, the Activator Adjusting Instrument 4 (AAI 4), with an adapter for use in animals, which has a 3- to 4-fold smaller contact surface area than the original rubber tip. METHODS Peak force was determined by thrusting the AAI 4 with the adapter or the original rubber tip onto a load cell. First, the AAI 4 was applied perpendicularly by a doctor of chiropractic onto the load cell. Then, the AAI 4 was fixed in a rigid framework and applied to the load cell. This procedure was done to prevent any load on the load cell before the thrust impulse. In 2 situations, trials were performed with the AAI 4 at all force settings (settings I, II, III, and IV, minimum to maximum, respectively). A total of 50000 samples per second over a period of 3 seconds were collected. RESULTS In 2 experimental protocols, the use of the adapter in the AAI 4 increased the peak force only with setting I. The new value was around 80% of the maximum value found for the AAI 4. Nevertheless, the peak force values of the AAI 4 with the adapter and with the original rubber tip in setting IV were similar. CONCLUSION The adapter effectively determines the maximum peak force value at force setting I of AAI 4.
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Affiliation(s)
- Felipe Coutinho Kullmann Duarte
- Academic Researcher, Department of Physiology, Institute of Basic Health Science, Federal University of Rio Grande do Sul/UFRGS, Porto Alegre, Brazil.
| | - Carolina Kolberg
- Academic Researcher, Department of Physiology, Institute of Basic Health Science, Federal University of Rio Grande do Sul/UFRGS, Porto Alegre, Brazil
| | - Rodrigo R Barros
- Technician, Department of Mechanical Engineering, School of Engineering, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Günter Gehlen
- Professor, Chiropractic Graduation Program from Feevale University, Novo Hamburgo, Brazil
| | - Jakson M Vassoler
- Professor and Academic Researcher, Department of Mechanical Engineering, School of Engineering, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Wania A Partata
- Professor and Academic Researcher, Department of Physiology, Institute of Basic Health Science, Federal University of Rio Grande do Sul/UFRGS, Porto Alegre, Brazil
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Sueki DG, Chaconas EJ. The effect of thoracic manipulation on shoulder pain: a regional interdependence model. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Boët C, Fugier S, Marsault J, Toublan D, Valot ME, Cheval A, Amyot d'Inville G, Niel S, Guihéneuc P, Guihard G. High-velocity low-amplitude thrust manipulation of the lumbar spine immediately modifies soleus T reflex in asymptomatic adults. INT J OSTEOPATH MED 2013. [DOI: 10.1016/j.ijosm.2013.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vaillant M, Edgecombe T, Long CR, Pickar JG, Kawchuk GN. The effect of duration and amplitude of spinal manipulative therapy (SMT) on spinal stiffness. MANUAL THERAPY 2012; 17:577-83. [PMID: 22809745 PMCID: PMC3477278 DOI: 10.1016/j.math.2012.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 06/07/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
Abstract
The aim of this study was to determine the effect of spinal manipulative therapy (SMT) force magnitude and force duration on the spinal stiffness of a feline preparation. A mechanical device performed simulated SMTs at the L6 spinous process in 22 anesthetised felines. Animals were divided into four groups. Two groups (no preload, preload) received SMT having maximal displacements of 1.0 mm, 2.0 mm and 3.0 mm of total displacement (displacement control). In two other groups (preload, no preload), SMTs were applied with maximal loads of 25%, 55% and 85% body weight (force control). Each of the SMTs were applied in order of increasing displacement or force amplitudes, at increasing durations ranging from 25 to 250 ms. Spinal stiffness was quantified by applying an indentation load to external surface of the back. Linear mixed effects models were fit for post-SMT stiffness variables. When SMT was applied under displacement control with and without a preceding preload, a significant interactive effect occurred between force magnitude and force duration (p ≤ 0.05) for some of the stiffness variables. The findings from this experiment demonstrate that spinal stiffness in a feline model was affected by the interaction of the force amplitude and force duration parameters but the exact nature of this interaction remains unclear. This study provides guidance for further investigation given other SMT parameters not tested here may facilitate the ability of SMT to alter spinal stiffness.
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Affiliation(s)
| | | | - Cynthia R. Long
- Palmer Center for Chiropractic Research, Davenport, Iowa, USA
| | - Joel G. Pickar
- Palmer Center for Chiropractic Research, Davenport, Iowa, USA
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The effects of thoracic spine manipulation in subjects with signs of rotator cuff tendinopathy. J Orthop Sports Phys Ther 2012; 42:1005-16. [PMID: 22951537 DOI: 10.2519/jospt.2012.4142] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study. OBJECTIVES To assess scapular kinematics and electromyographic signal amplitude of the shoulder musculature, before and after thoracic spine manipulation (TSM) in subjects with rotator cuff tendinopathy (RCT). Changes in range of motion, pain, and function were also assessed. BACKGROUND There are various treatment techniques for RCT. Recent studies suggest that TSM may be a useful component in the management of pain and dysfunction associated with RCT. METHODS Thirty subjects between 18 and 45 years of age, who showed signs of RCT, participated in this study. Changes in scapular kinematics and muscle activity, as well as changes in shoulder pain and function, were assessed pre-TSM and post-TSM using paired t tests and repeated-measures analyses of variance. RESULTS TSM did not lead to changes in range of motion or scapular kinematics, with the exception of a small decrease in scapular upward rotation (P = .05). The only change in muscle activity was a small but significant increase in middle trapezius activity (P = .03). After TSM, subjects demonstrated decreased pain during performance of the Jobe empty-can (mean ± SD change, 2.6 ± 1.1), Neer (2.6 ± 1.3), and Hawkins-Kennedy (2.8 ± 1.3) tests (all, P<.001). Subjects also reported decreased pain with shoulder flexion (mean ± SD change, 2.0 ± 1.5; P<.001) and improved shoulder function (force production, 2.5 ± 1.4 kg; Penn Shoulder Score, 7.7 ± 9.4; sports/performing arts module of the Disabilities of the Arm, Shoulder and Hand questionnaire, 16.4 ± 13.2) (all, P<.001). CONCLUSION Immediate improvements in shoulder pain and function post-TSM are not likely explained by alterations in scapular kinematics or shoulder muscle activity. For people with pain associated with RCT, TSM may be an effective component of their treatment plan to improve pain and function. However, further randomized controlled studies are necessary to better validate this treatment approach. LEVEL OF EVIDENCE Therapy, level 4.
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Wu LP, Huang YQ, Zhou WH, Manas D, Zhao WD, Chen JZ, Yin QS, Wang LH. Influence of Cervical Spine Position, Turning Time, and Cervical Segment on Cadaver Intradiscal Pressure During Cervical Spinal Manipulative Therapy. J Manipulative Physiol Ther 2012; 35:428-36. [DOI: 10.1016/j.jmpt.2012.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 04/11/2012] [Accepted: 05/17/2012] [Indexed: 11/25/2022]
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Colloca CJ, Gunzburg R, Freeman BJ, Szpalski M, Afifi M, Moore RJ. Biomechancial quantification of pathologic manipulable spinal lesions: an in vivo ovine model of spondylolysis and intervertebral disc degeneration. J Manipulative Physiol Ther 2012; 35:354-66. [PMID: 22657392 DOI: 10.1016/j.jmpt.2012.04.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 03/06/2012] [Accepted: 03/27/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purposes of this study were to quantify the biomechanical and pathologic consequences of surgically induced spinal lesions and to determine their response to spinal manipulation (SMT) in an in vivo ovine model. METHODS Of 24 Merino sheep, 6 received L5 spondylolytic defects, 6 received L1 annular lesions, and 12 served as respective controls. Dorsoventral (DV) stiffness was assessed using oscillatory loads (2-12 Hz). Two SMT force-time profiles were administered in each of the groups using a randomized and repeated-measures design. Stiffness and the effect of SMT on the DV motions and multifidus needle electromyographic responses were assessed using a repeated-measures analysis of variance (α = .05). Postmortem histologic analysis and computed tomography validated the presence of lesions. RESULTS L5 DV stiffness was significantly increased (40.2%) in the spondylolysis (6.28 N/mm) compared with the L5 control group (4.48 N/mm) (P < 03). Spinal manipulations delivered to the spondylolysis group resulted in less DV vertebral displacement (P < .01) compared with controls. Dorsoventral stiffness of the disc degeneration group was 5.66 N/mm, 94.5% greater than in the L1 control group (2.91 N/mm) (P < .01). One hundred-millisecond SMTs resulted in significantly reduced DV displacements in the disc degeneration group compared with the L1 control group (P < .01). Animals in the disc degeneration group showed a consistent 25% to 30% reduction in needle electromyographic responses to all SMTs. CONCLUSIONS Quantifiable objective evidence of spinal lesions and their response to SMT were confirmed in this study. Neuromechanical alterations provide novel insights into quantifying manipulable spinal lesions and a means to biomechanically assess SMT outcomes.
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Kumar S. Posteroanterior spinal stiffness at T5, T10, and L3 levels in normal subjects. PM R 2012; 4:342-8. [PMID: 22405682 DOI: 10.1016/j.pmrj.2011.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 12/06/2011] [Accepted: 12/14/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To measure, by using standardized device and protocol, posteroanterior (PA) spinal stiffness at the 5th and 10th thoracic (T5 and T10) and 3rd lumbar (L3) vertebral levels in asymptomatic adult volunteers. DESIGN A cross-sectional study. SETTING Osteopathic Heritage Foundation Physical Medicine Core Research Laboratory where the Therapeutic Spinal Mobilizer was fabricated to standardize the testing protocol. PARTICIPANTS Sixteen asymptomatic adult volunteers. METHODS Volunteers were in the prone position on the treatment plinth and the loading block of the loading piston was placed at T5, T10, and L3. The subjects were instructed to remain still, to not contract any muscle, and to stop breathing mid cycle for 15 seconds when the data acquisition was initiated for a 10-second test cycle. The force was measured by using the load cell, and the spinal deformation was measured by the linear variable differential transducer. The data were extracted and subjected to descriptive statistics and analysis of variance to determine the effect of independent variables on spinal stiffness. RESULTS The PA spinal stiffness at 3 spinal levels was significantly different (P < .0001). The spinal stiffness was significantly affected by the testing load, age, gender, and body weight of the subjects (P < .0001). The PA stiffness of the entire sample at 3 spinal levels ranged from 4.8-8.8 N/mm. The spinal stiffness values could be predicted as the function of testing load and body weight (P < .01). CONCLUSIONS Results of this experiment suggest that the standardized and repeatable methodology will result in reliable stiffness values. Because the spinal stiffness is an indicator of patient's symptoms and it is an important variable in selection of treatment regimen, it is important to be able to measure this variable with a standardized protocol. Values from asymptomatic subjects can be used to study and to compare the symptomatic patients.
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Affiliation(s)
- Shrawan Kumar
- Department of Osteopathic Manipulative Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
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Grindstaff TL, Hertel J, Beazell JR, Magrum EM, Kerrigan DC, Fan X, Ingersoll CD. Lumbopelvic joint manipulation and quadriceps activation of people with patellofemoral pain syndrome. J Athl Train 2012; 47:24-31. [PMID: 22488227 PMCID: PMC3418111 DOI: 10.4085/1062-6050-47.1.24] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
CONTEXT Quadriceps weakness and inhibition are impairments associated with patellofemoral pain syndrome (PFPS). Lumbopelvic joint manipulation has been shown to improve quadriceps force output and inhibition, but the duration of the effect is unknown. OBJECTIVE To determine whether quadriceps strength and activation are increased and maintained for 1 hour after high-grade or low-grade joint mobilization or manipulation applied at the lumbopelvic region in people with PFPS. DESIGN Randomized controlled clinical trial. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Forty-eight people with PFPS (age = 24.6 ± 8.9 years, height = 174.3 ± 11.2 cm, mass = 78.4 ± 16.8 kg) participated. INTERVENTION(S) Participants were randomized to 1 of 3 groups: lumbopelvic joint manipulation (grade V), side-lying lumbar midrange flexion and extension passive range of motion (grade II) for 1 minute, or prone extension on the elbows for 3 minutes. MAIN OUTCOME MEASURE(S) Quadriceps force and activation were measured using the burst superimposition technique during a seated isometric knee extension task. A 2-way repeated-measures analysis of variance was performed to compare changes in quadriceps force and activation among groups over time (before intervention and at 0, 20, 40, and 60 minutes after intervention). RESULTS We found no differences in quadriceps force output (F(5.33,101.18) = 0.65, P = .67) or central activation ratio (F(4.84,92.03) = 0.38, P = .86) values among groups after intervention. When groups were pooled, we found differences across time for quadriceps force (F(2.66,101.18) = 5.03, P = .004) and activation (F(2.42,92.03) = 3.85, P = .02). Quadriceps force was not different at 0 minutes after intervention (t(40) = 1.68, P = .10), but it decreased at 20 (t(40) = 2.16, P = .04), 40 (t(40) = 2.87, P = .01) and 60 (t(40) = 3.04, P = .004) minutes after intervention. All groups demonstrated decreased quadriceps activation at 0 minutes after intervention (t(40) = 4.17, P < .001), but subsequent measures were not different from preintervention levels (t(40) range, 1.53-1.83, P > .09). CONCLUSIONS Interventions directed at the lumbopelvic region did not have immediate effects on quadriceps force output or activation. Muscle fatigue might have contributed to decreased force output and activation over 1 hour of testing.
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Affiliation(s)
- Terry L Grindstaff
- Physical Therapy Department, Creighton University, Omaha, NE 68178, USA.
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Roy RA, Boucher JP, Comtois AS. Inflammatory response following a short-term course of chiropractic treatment in subjects with and without chronic low back pain. J Chiropr Med 2011; 9:107-14. [PMID: 22027032 DOI: 10.1016/j.jcm.2010.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 05/17/2010] [Accepted: 06/09/2010] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) have not been evaluated in response to a short course of lumbar spinal manipulation. The purpose of this study is to observe the responses of inflammatory markers (IL-6 and CRP) after a series of 9 chiropractic spinal manipulations. METHODS Twenty-one participants were assigned to a treatment or a control group. Only the treatment group received 9 chiropractic interventions. Pre- and postintervention measures were recorded for blood samples for detection of proinflammatory cytokines IL-6 and CRP. RESULTS Mediators of inflammation (IL-6 and high-sensitivity CRP) were modified by the intervention received in the treatment group, and the effect size demonstrated a tendency toward the control group values. CONCLUSION A total of 9 chiropractic lower back manipulations caused the mediators of inflammation to present a normalization response in individuals suffering from chronic low back pain.
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Affiliation(s)
- Richard A Roy
- PhD Graduate Student, Département de Kinanthropologie, Université du Québec à Montréal, Montréal, Québec, Canada; Chiropractor, Private Practice, LaSalle, Québec, Canada
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Botelho MB, Andrade BB. Effect of cervical spine manipulative therapy on judo athletes' grip strength. J Manipulative Physiol Ther 2011; 35:38-44. [PMID: 22079053 DOI: 10.1016/j.jmpt.2011.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/01/2011] [Accepted: 07/14/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The objective of this study was to perform an investigation evaluating if cervical spinal manipulative therapy (SMT) can increase grip strength on judo athletes in a top 10 national-ranked team. METHODS A single-blinded, prospective, comparative, pilot, randomized, clinical trial was performed with 18 athletes of both sexes from a judo team currently competing on a national level. The athletes were randomly assigned to 2 groups: chiropractic SMT and sham. Three interventions were performed on each of the athletes at different time points. Force measurements were obtained by a hydraulic dynamometer immediately before and after each intervention at the same period before training up to 3 weeks with at least 36 hours between interventions. RESULTS Analysis of grip strength data revealed a statistically significant increase in strength within the treatment group after the first intervention (6.95% right, 12.61% left) as compared with the second (11.53% right, 17.02% left) and the third interventions (10.53% right, 16.81% left). No statistically significant differences were found in grip strength comparison within the sham group. Overall differences in strength were consistently significant between the study groups (P = .0025). CONCLUSION The present study suggests that the grip strength of national level judo athletes receiving chiropractic SMT improved compared to those receiving sham.
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Grindstaff TL, Beazell JR, Sauer LD, Magrum EM, Ingersoll CD, Hertel J. Immediate effects of a tibiofibular joint manipulation on lower extremity H-reflex measurements in individuals with chronic ankle instability. J Electromyogr Kinesiol 2011; 21:652-8. [DOI: 10.1016/j.jelekin.2011.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 03/31/2011] [Accepted: 03/31/2011] [Indexed: 12/26/2022] Open
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Kumar S, Stoll S. Device, protocol and measurement of regional spinal stiffness. J Electromyogr Kinesiol 2011; 21:458-65. [DOI: 10.1016/j.jelekin.2011.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 12/14/2010] [Accepted: 01/05/2011] [Indexed: 10/18/2022] Open
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Triano JJ, Gissler T, Forgie M, Milwid D. Maturation in Rate of High-Velocity, Low-Amplitude Force Development. J Manipulative Physiol Ther 2011; 34:173-80. [DOI: 10.1016/j.jmpt.2011.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 01/04/2011] [Accepted: 01/14/2011] [Indexed: 10/18/2022]
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Immediate effects of a high-velocity spine manipulation in paraspinal muscles activity of nonspecific chronic low-back pain subjects. ACTA ACUST UNITED AC 2010; 15:469-75. [DOI: 10.1016/j.math.2010.03.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 03/24/2010] [Accepted: 03/26/2010] [Indexed: 11/23/2022]
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What is 'manipulation'? A reappraisal. ACTA ACUST UNITED AC 2010; 15:286-91. [PMID: 20080431 DOI: 10.1016/j.math.2009.12.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 11/03/2009] [Accepted: 12/21/2009] [Indexed: 11/19/2022]
Abstract
Due primarily to its colloquial function, 'manipulation' is a poor term for distinguishing one healthcare intervention from another. With reports continuing to associate serious adverse events with manipulation, particularly relating to its use in the cervical spine, it is essential that the term be used appropriately and in accordance with a valid definition. The purpose of this paper is to identify empirically-derived features that we propose to be necessary and collectively sufficient for the formation of a valid definition for manipulation. A final definition is not offered. However, arguments for and against the inclusion of features are presented. Importantly, these features are explicitly divided into two categories: the 'action' (that which the practitioner does to the recipient) and the 'mechanical response' (that which occurs within the recipient). The proposed features are: 1) A force is applied to the recipient; 2) The line of action of this force is perpendicular to the articular surface of the affected joint; 3) The applied force creates motion at a joint; 4) This joint motion includes articular surface separation; 5) Cavitation occurs within the affected joint.
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Hawk C, Cambron JA, Pfefer MT. Pilot study of the effect of a limited and extended course of chiropractic care on balance, chronic pain, and dizziness in older adults. J Manipulative Physiol Ther 2009; 32:438-47. [PMID: 19712786 DOI: 10.1016/j.jmpt.2009.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 05/09/2009] [Accepted: 05/21/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to collect preliminary information on the effect of a limited and extended course of chiropractic care on balance, chronic pain, and associated dizziness in a sample of older adults with impaired balance. METHODS The authors conducted a randomized pilot study targeting a sample size of 30, comparing 2 schedules of chiropractic care to a no-treatment group. Group 1 (limited schedule) was treated for 8 weeks, group 2 (extended schedule) was treated for 8 weeks and then once per month for 10 months, and group 3 received no treatment. Assessments were made at baseline and 1, 2, 6, and 12 months later. The primary outcome was changed in the Berg Balance Scale (BBS) from baseline to 1 year. Changes in the Pain Disability Index and Dizziness Handicap Index were also measured. RESULTS Thirty-four patients were enrolled, 13 in group 1, 15 in group 2, and 6 in group 3. Only 5 had baseline BBS scores less than 45, indicating increased risk for falls. There were no treatment-related adverse events. Nine patients dropped out by 1 year. No significant differences within or between groups in median BBS from baseline to 12 months were observed. Median Pain Disability Index scores improved more from baseline to 1 year in group 2 compared with groups 1 and 3 (P = .06, Kruskal-Wallis test). For the 9 patients with dizziness, a clinically significant improvement in Dizziness Handicap Index scores of groups 1 and 2 was observed at 1 month and remained lower than baseline thereafter; this was not true of group 3. CONCLUSION Further investigation of the possible benefit of chiropractic maintenance care (extended schedule) for balance and pain-related disability is feasible and warranted, as well as both limited and extended schedules for patients with idiopathic dizziness.
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Affiliation(s)
- Cheryl Hawk
- Cleveland Chiropractic College, Kansas City, Mo, USA.
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Kawchuk GN, Perle SM. The relation between the application angle of spinal manipulative therapy (SMT) and resultant vertebral accelerations in an in situ porcine model. ACTA ACUST UNITED AC 2009; 14:480-3. [PMID: 19144558 DOI: 10.1016/j.math.2008.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 10/21/2008] [Accepted: 11/08/2008] [Indexed: 11/19/2022]
Abstract
It has been hypothesized that the posterior tissues of the spine are frictionless and therefore allow only the normal force component of spinal manipulative therapy (SMT) to pass to underlying vertebrae. Given this assumption, vertebrae could not be moved in practitioner-defined directions by altering the application angle of SMT. To investigate this possibility, porcine lumbar spines were excised and then SMT applied at 90 degrees to the posterior tissues of the target vertebra. A standard curve was constructed of increasing SMT force versus vertebral acceleration. SMT forces were then applied at 60 degrees and 120 degrees and the resulting accelerations substituted into the standard curve to obtain the transmitted force. Results showed that vertebral accelerations were greatest at a 90 degrees SMT application angle and decreased in all axes at application angles not equa l90 degrees . The average decrease in transmitted force using application angles of 60 degrees and 120 degrees was within 5% of the predicted absolute value. In this model, SMT applied at a non-normal angle does not increase vertebral acceleration in that same direction, but acts to reduce transmitted force. This work provides justification for future studies in less available human cadavers. It is not yet known if variations in SMT application angle have relevance to clinical outcomes or patient safety.
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Affiliation(s)
- Gregory N Kawchuk
- University of Alberta, Faculty of Rehabilitation Medicine, 3-44 Corbett Hall, Edmonton, Alberta, Canada T6G 2G4.
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Grindstaff TL, Hertel J, Beazell JR, Magrum EM, Ingersoll CD. Effects of lumbopelvic joint manipulation on quadriceps activation and strength in healthy individuals. ACTA ACUST UNITED AC 2008; 14:415-20. [PMID: 18805726 DOI: 10.1016/j.math.2008.06.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 05/24/2008] [Accepted: 06/28/2008] [Indexed: 12/13/2022]
Abstract
Lumbopelvic joint manipulation has been shown to increase quadriceps force output and activation, but the duration of effect is unknown. It is also unknown whether lower grade joint mobilisations may have a similar effect. Forty-two healthy volunteers (x+/-SD; age=28.3+/-7.3 yr; ht=172.8+/-9.8 cm; mass=76.6+/-21.7 kg) were randomly assigned to one of three groups (lumbopelvic joint manipulation, 1 min lumbar passive range of motion (PROM), or prone extension on elbows for 3 min). Quadriceps force and activation were measured using the burst-superimposition technique during a seated isometric knee extension task before and at 0, 20, 40, and 60 min following intervention. Collectively, all groups demonstrated a significant decrease (p<0.001) in quadriceps force output without changes in activation (p>0.05) at all time intervals following intervention. The group that received a lumbopelvic joint manipulation demonstrated a significant increase in quadriceps force (3%) and activation (5%) (p<0.05) immediately following intervention, but this effect was not present after the 20 min interval. Since participants in this study were free of knee joint pathology, it is possible that they did not have the capacity to allow for large changes in quadriceps muscle activation to occur.
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Hebert J, Koppenhaver S, Fritz J, Parent E. Clinical Prediction for Success of Interventions for Managing Low Back Pain. Clin Sports Med 2008; 27:463-79, ix-x. [DOI: 10.1016/j.csm.2008.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Colloca CJ, Keller TS, Moore RJ, Gunzburg R, Harrison DE. Intervertebral disc degeneration reduces vertebral motion responses. Spine (Phila Pa 1976) 2007; 32:E544-50. [PMID: 17762796 DOI: 10.1097/brs.0b013e318145ac39] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective in vivo experimental animal study. OBJECTIVE To determine the effects of disc degeneration and variable pulse duration mechanical excitation on dorsoventral lumbar kinematic responses. SUMMARY OF BACKGROUND DATA In vitro and in vivo biomechanical studies have examined spine kinematics during posteroanterior loading mimicking spinal manipulation therapy (SMT), but few (if any) studies have quantified SMT loading-induced spinal motion responses in the degenerated intervertebral disc. METHODS Fifteen sheep underwent a survival surgical procedure resulting in chronic disc degeneration of the L1-L2 disc. Ten age- and weight-matched animals served as controls. Uniform pulse dorsoventral mechanical forces (80 N) were applied to the L3 spinous processes using 10-, 100-, and 200-ms duration pulses mimicking SMT. L3 displacement and L2-L1 acceleration in the control group were compared with the degenerated disc group. RESULTS Dorsoventral displacements increased significantly (fivefold, P < 0.001) with increasing mechanical excitation pulse duration (control and degenerated disc groups). Displacements and L2-L1 acceleration transfer were significantly reduced (approximately 19% and approximately 50%, respectively) in the degenerated disc group compared with control (100- and 200-ms pulse duration protocols, P < 0.01). CONCLUSION Dorsoventral vertebral motions are dependent on mechanical excitation pulse duration and are significantly reduced in animals with degenerated discs.
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Affiliation(s)
- Christopher J Colloca
- Department of Kinesiology, Biomechanics Laboratory, Exercise and Sport Science Research Institute, Arizona State University, Tempe, AZ, USA.
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Colloca CJ, Keller TS, Moore RJ, Gunzburg R, Harrison DE. Effects of disc degeneration on neurophysiological responses during dorsoventral mechanical excitation of the ovine lumbar spine. J Electromyogr Kinesiol 2007; 18:829-37. [PMID: 17468010 DOI: 10.1016/j.jelekin.2007.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2006] [Revised: 02/06/2007] [Accepted: 02/07/2007] [Indexed: 11/22/2022] Open
Abstract
Mechanisms of spinal manipulation and mobilization include the elicitation of neuromuscular responses, but it is not clear how these responses are affected or altered by disc degeneration. We studied the neurophysiological responses of the normal and degenerated ovine spine subjected to mechanical excitation (varying force amplitude and duration) consistent with spinal manipulative therapy (SMT). Needle electromyographic (EMG) multifidus muscle activation adjacent to the L3 and L4 spinous processes and compound action potentials (CAPs) of the L4 nerve roots were measured during the application of dorsoventral mechanical excitation forces designed to mimic SMT force-time profiles used routinely in clinical practice. The magnitude and percentage of positive EMG responses increased with increasing SMT force magnitude, but not SMT pulse duration, whereas CAP responses were greatest for shorter duration pulses. Disc degeneration was associated with a reduction (20-25%) in positive EMG responses, and a concomitant increase (4.5-10.2%) in CAP responses.
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Affiliation(s)
- Christopher J Colloca
- Department of Kinesiology, Research Institute, Arizona State University, Tempe, AZ, USA.
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Yantzer BK, Freeman TB, Lee WE, Nichols T, Inamasu J, Guiot B, Johnson WM. Torsion-induced pressure distribution changes in human intervertebral discs: an in vitro study. Spine (Phila Pa 1976) 2007; 32:881-4. [PMID: 17426632 DOI: 10.1097/01.brs.0000259838.40738.1f] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Biomechanical testing of human cadaveric lumbar specimens was performed to evaluate the effects of torsional torque on intradiscal pressure and disc height. OBJECTIVE Evaluate the effects of small torsion torques on intradiscal pressure and disc height in human lumbar specimens. SUMMARY OF BACKGROUND DATA Nuclear depressurization in addition to an instantaneous disc height increase were found in previous porcine research when small (<2 degrees) axial vertebral rotations were applied. If applicable to human spines, this phenomenon may support spinal manipulation for the relief of low back pain. METHODS Six human lumbar cadaveric functional spine units (FSU) were loaded in the neutral position with 600 N axial compression. Intranuclear pressure measurements were then obtained at 0, 0.5, 1.0, and 2.0 Nm of torsion. Posterior elements were removed and measurements were repeated for the disc body unit (DBU). RESULTS There was no statistically significant difference in nuclear pressure or intervertebral disc height with different torsion torques among or between the FSUs and DBUs. However, a disc height increase ranging from 0.13 mm to 0.16 mm occurred with the insertion of a 1.85-mm diameter pressure probe cannula. CONCLUSIONS Small torsion torques showed no significant difference in intradiscal pressures or disc heights. This is an unlikely mechanism for the perceived benefits of spinal manipulation.
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Affiliation(s)
- Brenda K Yantzer
- Department of Neurological Surgery and Rehabilitation, University of South Florida, Tampa, FL, USA
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Colloca CJ, Keller TS. Spinal manipulation reduces pain and hyperalgesia after lumbar intervertebral foramen inflammation in the rat. J Manipulative Physiol Ther 2007; 30:76; author reply 77. [PMID: 17224360 DOI: 10.1016/j.jmpt.2006.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Indexed: 11/25/2022]
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Cramer G, Budgell B, Henderson C, Khalsa P, Pickar J. Basic Science Research Related to Chiropractic Spinal Adjusting: The State of the Art and Recommendations Revisited. J Manipulative Physiol Ther 2006; 29:726-61. [PMID: 17142166 DOI: 10.1016/j.jmpt.2006.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 09/06/2006] [Accepted: 09/12/2006] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objectives of this white paper are to review and summarize the basic science literature relevant to spinal fixation (subluxation) and spinal adjusting procedures and to make specific recommendations for future research. METHODS PubMed, CINAHL, ICL, OSTMED, and MANTIS databases were searched by a multidisciplinary team for reports of basic science research (since 1995) related to spinal fixation (subluxation) and spinal adjusting (spinal manipulation). In addition, hand searches of the reference sections of studies judged to be important by the authors were also obtained. Each author used key words they determined to be most important to their field in designing their individual search strategy. Both animal and human studies were included in the literature searches, summaries, and recommendations for future research produced in this project. DISCUSSION The following topic areas were identified: anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system. A relevant summary of each topic area and specific recommendations for future research in each area were the primary objectives of this project. CONCLUSIONS The summaries of the literature for the 6 topic sections (anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system) indicated that a significant body of basic science research evaluating chiropractic spinal adjusting has been completed and published since the 1997 basic science white paper. Much more basic science research in these fields needs to be accomplished, and the recommendations at the end of each topic section should help researchers, funding agencies, and other decision makers develop specific research priorities.
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Affiliation(s)
- Gregory Cramer
- Department of Research, National University of Health Sciences, Lombard, Ill. 60148, USA.
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Keller TS, Colloca CJ, Moore RJ, Gunzburg R, Harrison DE, Harrison DD. Three-dimensional vertebral motions produced by mechanical force spinal manipulation. J Manipulative Physiol Ther 2006; 29:425-36. [PMID: 16904488 DOI: 10.1016/j.jmpt.2006.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 01/26/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to quantify and compare the 3-dimensional intersegmental motion responses produced by 3 commonly used chiropractic adjusting instruments. METHODS Six adolescent Merino sheep were examined at the Institute for Medical and Veterinary Science, Adelaide, Australia. In all animals, triaxial accelerometers were attached to intraosseous pins rigidly fixed to the L1 and L2 spinous processes under fluoroscopic guidance. Three handheld mechanical force chiropractic adjusting instruments (Chiropractic Adjusting Tool [CAT], Activator Adjusting Instrument IV [Activator IV], and the Impulse Adjusting Instrument [Impulse]) were used to randomly apply posteroanterior (PA) spinal manipulative thrusts to the spinous process of T12. Three force settings (low, medium, and high) and a fourth setting (Activator IV only) were applied in a randomized repeated measures design. Acceleration responses in adjacent segments (L1 and L2) were recorded at 5 kHz. The multiaxial intersegmental (L1-L2) acceleration and displacement response at each force setting was computed and compared among the 3 devices using a repeated measures analysis of variance (alpha = .05). RESULTS For all devices, intersegmental motion responses were greatest for axial, followed by PA and medial-lateral (ML) measurement axes for the data examined. Displacements ranged from 0.11 mm (ML axis, Activator IV low setting) to 1.76 mm (PA axis, Impulse high setting). Compared with the mechanical (spring) adjusting instruments (CAT, Activator IV), the electromechanical Impulse produced the most linear increase in both force and intersegmental motion response and resulted in the greatest acceleration and displacement responses (high setting). Significantly larger magnitude intersegmental motion responses were observed for Activator IV vs CAT at the medium and high settings (P < .05). Significantly larger-magnitude PA intersegmental acceleration and displacement responses were consistently observed for Impulse compared with Activator IV and CAT for the high force setting (P < .05). CONCLUSIONS Larger-magnitude, 3D intersegmental displacement and acceleration responses were observed for spinal manipulative thrusts delivered with Impulse at most force settings and always at the high force setting. Our results indicate that the force-time characteristics of impulsive-type adjusting instruments significantly affects spinal motion and suggests that instruments can and should be tuned to provide optimal force delivery.
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Affiliation(s)
- Tony S Keller
- Musculoskeletal Research Foundation, Florida Orthopaedic Institute, Temple Terrace, Fla., USA.
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